THORACOSCOPIC OPERATIONS ON REOPERATED CHESTS

Background. A previous operation is generally considered to be a relat ive contraindication to the minimal access approach. We reviewed our c ombined experience from three centers with video-assisted thoracic sur gery on reoperated chests. Methods. From September 1992 to December 19 96, 2,477 patients underwent video-assisted thoracic surgery of whom 4 0 patients (33 men; age range, 9 to 78 years) had prior operations on the ipsilateral side of the chest: 23 after prior open procedures (22 thoracotomies, 1 median sternotomy) and 17 after video-assisted thorac ic surgery. The second procedures consisted of bullectomy or bulla lig ation (8), mediastinal and hilar mass biopsy (8), wedge lung resection (6), pericardial window (5), lung volume reduction (4), redo thoracod orsal sympathectomy (3), talc insufflation alone (3), decortication (2 ), and suturing of a pleural rent (1). Results. Adhesions were noted i n all patients ranging from minimal to strong fibrous adhesions. Howev er, in only 2 patients (5%) were the procedures abandoned because of a dhesions. Video-assisted thoracic surgery was safely completed in all other patients. There was no mortality or intraoperative complications and mean hospital stay was 5.1 +/- 3.2 days (range, 0 to 17 days). Co nclusions. Video-assisted thoracic surgery on reoperated chests is fea sible and does not carry a higher morbidity or mortality compared with first-time operations, even though it may be technically more difficu lt. Experience and clinical judgment, however, are required to select these patients for reoperation with video-assisted thoracic surgery.