DIAGNOSTIC AND THERAPEUTIC THORACOSCOPY - LESSONS FROM THE LEARNING-CURVE

A variety of video-assisted thoracic operations are being reported wit h increasing frequency. Problems encountered during the development of this technology have received less attention. During the course of 27 months, 69 consecutive patients underwent minimally invasive procedur es at our institution. Conversion to thoracotomy was required in 16 of 49 (33%) patients undergoing diagnostic procedures and 1 of 20 (5%) p atients undergoing therapeutic interventions. Fewer complications occu rred in those patients with diagnostic procedures (10 of 49, 20%) vers us therapeutic interventions (10 of 20, 50%; p = 0.01). Logistic regre ssion analysis showed chronic obstructive pulmonary disease to be an i ndependent risk factor for complications. The mean postoperative stay was 7.9 +/- 6.8 days for diagnostic and 12.8 +/- 9.7 days for therapeu tic interventions (p = 0.02). As new technologic improvements were int roduced; the mean hospital stay decreased (first 10 months: 14.6 +/- 1 0.0 days, 10 to 20 months: 9.8 +/- 9.6 days, more than 20 months: 5.2 +/- 3.0 days, p <0.004). The surgeon's thoracoscopic experience was no t as strongly predictive (5 or fewer cases: 8.9 +/- 5.9 days, 6 to 15 cases: 13.1 +/- 12.6 days, more than 15 cases: 5.0 +/- 2.0 days). Alth ough thoracoscopic surgery is promising, the potential for problems re quires careful surgical judgment and expertise in dealing with thoraci c complications.