SIMULTANEOUS VS STAGED BILATERAL VIDEO-ASSISTED THORACOSCOPIC SURGERY

It is generally thought that simultaneous bilateral chest surgery carr ies a high morbidity. We reviewed the results of simultaneous (under o ne anesthesia) vs staged bilateral video-assisted thoracoscopic surger y (VATS) from a single institution over a 35-month period. From Septem ber 1992 to July 1995, we performed simultaneous bilateral VATS on 37 patients (31 males, six females, age ranging from 15 to 55 years) with spontaneous pneumothorax (20) for bleb resections and pleurodesis; th oracodorsal sympathectomy (12) for palmar hyperhidrosis and vasospasti c disease; and metastatic sarcomas (five) for wedge lung resections. D uring the same period, nine patients with metachronous bilateral spont aneous pneumothorax had staged procedures, as did two with digital isc hemic ulcers for sympathectomy and three with metastatic pulmonary ost eosarcomas for resection. Mean postoperative hospital stays in days fo r the simultaneous groups were 3.3 for spontaneous pneumothorax, 2.1 f or sympathectomy, and 1.5 for wedge resection, compared to 2.9, 2.5, a nd 2.2 for the staged groups, respectively (p > 0.05 by Mann-Whitney U tests). Likewise, pain assessment by visual analogue scale as well as analgesic requirement showed no significant difference between the si multaneous and the staged groups. We conclude that simultaneous VATS i s not associated with increased morbidity or prolonged hospital stay c ompared to the staged counterparts and provides an attractive alternat ive to the median sternotomy, bilateral posterolateral thoracotomy, or transternal (clam-shell) thoracotomy for selected cases of simultaneo us bilateral lung surgery.