VIDEO-ASSISTED THORACOSCOPY

Recent advances in video-imaging and minimally invasive surgical instr umentation have expanded the role of thoracoscopy in the diagnosis and treatment of intrathoracic conditions. This prospective study describ es the use of video-assisted thoracoscopy (VAT) in 100 consecutive pat ients. There were 70 males and 30 females with a mean age of 54.6. The y underwent 103 VAT procedures with 41 thoracoscopic biopsies of lung, pleural, chest wall and mediastinal abnormalities, 32 for treatment o f recurrent or persistent pneumothorax, 18 for thoracoscopic assessmen t of pulmonary and pleural tumours and 12 for thoracoscopic resection of peripheral lung lesions, chest wall, mediastinal and pleural tumour s. Eighty-one patients had VAT procedures alone while the remaining 19 had VAT proceeding to thoracotomy. The mean operating time for VAT al one was 51 min (range 30-135 min). There were no operative deaths. The re were 8 significant complications from which patients recovered full y. Patients who underwent VAT alone were shown to have earlier postope rative mobilization, reduction in parenteral analgesic requirement and reduced length of hospital stay compared to patients undergoing addit ional thoracotomy. A telephone survey of patients on returning home sh owed that patients undergoing VAT alone returned to full activity earl ier than those who had thoracotomy (mean 9.0 vs mean 19.4 days). This study confirms that VAT is a safe and effective procedure in the manag ement of pulmonary, mediastinal and pleural disease and the treatment of persistent and recurrent pneumothorax. Its role in the resection of pulmonary malignancy remains to be defined.