VIDEOENDOSCOPIC ATYPICAL PULMONARY RESECT ION

A new era in thoracoscopy within the framework of minimal invasive tho racic surgery was introduced due to the possibilities of video-endosco py, the development of an accordingly advanced and suitable instrument arium as well as the production of an endoscopically applicable linear stapler. The introduction of the endo-staplers has made the thoracosc opic resection even of larger parts of lung parenchyme possible. Just as in laparoscopy a clear reduction of post-operative pain, a reduced impairment of postoperative pulmonary function, a shorter in hospital stay and an earlier return to normal activities are advantages of thor acoscopy when compared to the severely more traumatising thoracotomy. Good indications for this procedure are the spontaneous pneumothorax a nd the resection biopsy in the quest of finding the diagnosis of uncle ar pulmonary disease. For the diagnostic and should the situation aris e therapeutic resection of solitary pulmonary nodules in contrast a st ricter selection and handling of indications is imperative. The method however proved worthwile under such conditions. The technique and res ults are reported of video thoracoscopies in 73 patients as well as 51 atypical lung resections carried out thoracoscopically with the Endo- GIA(TM)30. A switch to open thoracotomy became necessary in 16.4%. Ind ications were pneumothorax (35.6%), hemothorax (1.3%), diagnostic rese ction of solitary nodule (42.5%), pneumopathy (11.0%), and extrapulmon ary tumor (9.6%). Atypical resections were carried out only in the cas e of solitary nodule (51.7%), pneumothorax (39.7%), and pneumopathy (8 .6%). A histological diagnosis was obtained in all cases. The average operating time for solitary nodule and pneumothorax was 1 hour, for pn eumopathy 1/2 hour. Chest drains could be removed after 1.62. 6 days. The postoperative complication rate amounted to 3.9%. There was no mor tality. The introduced procedure represents a new and promising altern ative in thoracic surgery.