IS VIDEO-ASSISTED THORACOSCOPIC SURGERY I NDICATED IN ONCOLOGY

Video-assisted thoracoscopic surgery (VATS) is not to be accepted in o ncologic patients at present. Up till now, the technical facilities ar e not as advanced as to compete with the established procedures of con ventional surgery. The thoracoscopic, more indirect surgical methods a re not able to adequately adjust to the specific growth pattern and pa ths of metastatic spread of bronchial carcinoma. Surgery for pulmonary metastasis has to be considered under the same aspects. Preoperative staging of lung cancer and the location and number of pulmonary metast ases cannot be sufficiently assessed by computed tomography. Consequen tly, palpation of both the inflated and deflated lung is mandatory. On cologic surgery includes complete lymph node dissection in all compart ments, which cannot be achieved by VATS at present. It is irresponsibl e to risk the internationally quite homogenous stage-related results o btained in bronchial carcinoma for the sake of some new technical equi pment. In surgery for lung metastasis, curative treatment demands to c ompletely remove all lesions and the corresponding lymph nodes. This m anagement alone promisses benefit for the patient. VATS is established in 1) removal of coin lesions (change to open surgery in case of mali gnancy; 2) diagnostic resection in metastasis surgery. Results after V ATS have to be assessed for quality control in VATS in the same way as it is done for open surgery.