RISK AND HAZARDS OF VIDEO-THORACOSCOPIC SURGERY - A COLLECTIVE REVIEW

Objective. Since 1990, video-thoracoscopy has rapidly gained widesprea d acceptance. In contrast to conventional thoracoscopy no comprehensiv e studies of potential risks and hazards have been carried out. To dat e interest has centered on possible indications and thoracoscopic tech niques. Based on a review of the literature, this article summarizes a nd comments on possible complications. Methods. In a meta-analysis (Me dline, January 1989 until December 1994), all publications dealing wit h thoracoscopy were collected. Those papers concerned with video-thora coscopy were further evaluated if the following criterias were fulfill ed: first, the endoscopist employed a video-camera connected to the th oracoscope; second, separate entry sites were used for telescope and i nstruments. Results. Of 345 papers, 145 met the above criterias, 5280 thoracoscopies could be analysed for more than 30 indications. The cal culated mortality rate was 0.3% and the complication rate 3.61%. In 55 of all cases (1.04%), the intervention had to be converted to open su rgery. Conclusions. Video-thoracoscopic thoracic surgery has gained ac ceptance as a complement to open thoracic surgery. It may now be regar ded as a safe technique. Nevertheless, serious complications such as i mplantation metastasis of the thoracic wall after thoracoscopy or inju ry to the recurrens nerve demonstrate the complexity of thoracoscopic surgery. Practitioners should therefore be proficient in thoracic surg ery. The importance of meticulous technique and rigid adherance to saf ety guidelines even in diagnostic procedures, must be stressed.