THORACOSCOPY VERSUS THORACOTOMY - INDICATIONS AND ADVANTAGES

Although the diagnosis and treatment of intrathoracic diseases have be en affected by the use of thoracoscopy, the indications and advantages of this procedure are poorly defined. To review the indications and r esults in a community practice, 52 consecutive cases of thoracoscopy w ere reviewed and the postoperative courses were compared to a control group of 43 simultaneous thoracotomies. Operative indications for thor acoscopy included investigation or treatment of a lung mass (n = 33), spontaneous pneumothorax (n = 10), mediastinal mass (n = 4) pleural ef fusion (n = 2), mesothelioma (n = 2), and a ruptured hemidiaphragm (n = 1). General endotracheal anesthesia was used in each case. Overall, thoracoscopy was successful in 40 cases (77%). Conversion to formal th oracotomy was required in 14 cases (27%) secondary to poor visualizati on or to aid in further dissection. Compared to thoracotomy, complicat ion rates were less (7.6 vs 16.2%), hospital stay shorter (5.5 vs 8 da ys), ICU stay shorter (0 vs 2 days) and pleural drainage time less (2 vs 5 days) in the thoracoscopy group. in summary, 73% of the patients in this study who formerly would have undergone thoracotomy were succe ssfully managed with thoracoscopy alone, with acceptable morbidity and mortality. These data define the indications, morbidity, and mortalit y of thoracoscopy and suggest that thoracoscopy may emerge as the proc edure of choice in the diagnosis and management of many thoracic disea ses.