COMPARISON OF OPEN VERSUS THORACOSCOPIC LUNG-BIOPSY FOR DIFFUSE INFILTRATIVE PULMONARY-DISEASE

Background: Patients with diffuse pulmonary infiltrates often require biopsy for a diagnosis. Standard operative therapy, open wedge resecti on via thoracotomy, is associated with known morbidity. We hypothesize d that closed thoracoscopic wedge resection may result in reduced morb idity and decreased duration of hospital stay. This retrospective stud y compares open resection with thoracoscopic wedge resection in patien ts with diffuse pulmonary infiltrates. Methods: Seventy-five patients with diffuse pulmonary infiltrates underwent diagnostic lung biopsy. P atients requiring mechanical ventilation and high levels of pressure s upport before biopsy were excluded from the study. Between March 1987 and September 1991, a total of 28 patients underwent open wedge resect ion via lateral thoracotomy. Since April 1991, a total of 47 patients underwent thoracoscopic resection. Results. There was no difference be tween the groups in age, sex, presence of immunosuppression, or final pathologic diagnosis. Adequate tissue was obtained for pathologic diag nosis in all patients of both groups. All surgeons believed that thora coscopic biopsy provided better visualization of the entire lung than did a limited thoracotomy. Mean operative time was 69 minutes for open biopsies and 93 minutes for thoracoscopic biopsies [p = 0.038]. Mean duration of chest tube drainage was not significantly different betwee n the two groups. Duration of hospital stay was significantly less for thoracoscopic biopsy (4.9 days) than for open biopsy (12.2 days) (p = 0.018). Fourteen of 28 open biopsies resulted in complications compar ed with 9 of 47 closed biopsies (p = 0.009). Tere were 6 deaths among patients having open biopsies and 3 deaths among those having closed b iopsies (p = not significant). Conclusion: A significant decrease in h ospital stay was noted with thoracoscopic biopsy when compared with lu ng biopsy via the standard open approaches. Thoracoscopy provided exce llent visualization and allowed for wedge resection that provided adeq uate tissue for diagnosis in patients with diffuse pulmonary interstit ial disease.