THE SAFETY AND VERSATILITY OF VIDEO-THORACOSCOPY - A PROSPECTIVE ANALYSIS OF 895 CONSECUTIVE CASES

BACKGROUND: The application of video-endoscopy to general thoracic sur gery is radically changing the approach to many benign and malignant d iseases of the chest. Since July 1991, we have performed 794 purely th oracoscopic and 101 video-assisted thoracic surgical (VATS) procedures on 860 patients. STUDY DESIGN: Comprehensive, prospectively acquired data examining the specific indications for and outcomes of this new t echnique were prospectively entered into a thoracic surgical database. Preoperative, intraoperative, postoperative, and outcome variables we re studied for the entire group as well as three high-risk cohorts: ag e over 70 years (n=198), forced expiratory volume in one second (FEV(1 )) of less than 1 L (n=46), and Karnofsky performance index of less th an 8 (n=61). RESULTS: The 895 cases involved 449 men and 446 women of ages 15 to 89 years (mean 56 +/- 16 years standard deviation). The ind ications for surgery were diagnostic in 501 cases (56 percent), therap eutic in 244 cases (27 percent), and both diagnostic and therapeutic i n an additional 150 cases (17 percent). The specific procedures perfor med were operations on the lung (569 cases), pleura (196 cases), esoph agus (42 cases), mediastinum (51 cases), and pericardium (37 cases). F ifty-seven percent of the procedures were for a malignant process and 43 percent were for benign or infectious pathology. There were nine de aths for a series operative mortality rate of 1.0 percent. Thirteen pa tients (1.4 percent) required conversion to a limited thoracotomy for technical reasons. There were 127 complications in 121 patients yieldi ng a morbidity rate in all patients of 14 percent. Mortality rates in the elderly, poor lung function, and depressed performance index cohor ts were 1.5, 2.1, and 9.8 percent, respectively. Morbidity rates in th ese high-risk populations were 19, 30, and 18 percent, respectively. T he median postoperative length of stay was three days after closed tho racoscopy and five days after VATS resection. CONCLUSIONS: These data underscore the flexibility, safety, efficacy, and potential for cost s avings of videoscopic surgery in patients with thoracic diseases. The ability to perform excisional biopsy improves diagnostic specificity a nd sensitivity to nearly 100 percent. Video-assisted thoracic surgical techniques also offer a minimally invasive procedure with acceptable risk to patients heretofore inoperable by standard thoracotomy.