DIAGNOSTIC AND THERAPEUTIC VIDEO-THORACOS COPY - CONVERSION RATE AND COST-ANALYSIS

With the further development of new surgical techniques, that allow fo r the performance of a variety of standard diagnostic and therapeutic procedures in a less invasive fashion, it is instructive to look at th e complications of these new techniques, in order to define their role for general thoracic surgery. 372 patients have been treated by means of video-assisted thoracic surgery (VATS) between 1/1992 and 12/1994. A total of 934 open thoracic procedures were performed in the same ti me frame, 399 out of them for the same chest disorders as treated by V ATS alternatively. In 40 cases (10.7 %) the endoscopic procedure had t o be converted to an open thoracotomy. The main reasons for conversion were unability to locate or resect lesions due to a deep or central p osition (n = 13), requirement of further resection (n = 10), adhesions (n = 9), fibrinopurulent empyema (n = 5), bleeding (n = 2) and single -lung-ventilation failure (n = 1). The mean operation time was signifi cantly shorter with VATS compared to open procedures, except for decor tications. The mean hospital stay was 4.2 days in the endoscopic and 7 .9 days in the thoracotomy group. Cost analysis for both techniques in cluded expenses for disposable instruments, the operation room, anesth esia, and total hospital charges. Higher costs for instruments for VAT S procedures were compensated by shorter chest drainage, less postoper ative need for analgetics and a significantly shorter hospital stay. V ATS can be recommended as the technique of choice for certain indicati ons in thoracic surgery including treatment of spontaneous pneumothora x, wedge resection of indeterminate peripheral pulmonary nodules, open lung biopsies in a not ventilator dependent patient and biopsies of m ediastinal masses not suitable for mediastinoscopy.