Video-assisted thoracoscopic surgery in the diagnosis and treatment of chest diseases

Video-assisted thoracoscopic surgery (VATS) has been used recently in the d iagnosis and management of thoracic diseases. In this report, VATS experien ce with 95 cases, focusing on indications, surgical procedures, complicatio ns, and failure rates, are reviewed. Over the past 5 years, 95 VATS procedu res for diagnostic and therapeutic purposes were performed in 59 men and 36 women. The specific indications for VATS were lung biopsy for undiagnosed diffuse lung disease (48), mediastinal biopsy (12) and cyst (2), pleural ef fusion (10), empyema (5), pneumothorax and bullous lung disease (6), perica rdial effusion (2) and cyst (2), paravertebral abscess (2), solitary pulmon ary nodules (3), and thoracic trauma (3). In all patients, postoperative pa in was controlled with non-narcotic analgesics and was measured according t o the visual analogue scale (VAS). There was no surgical mortality. Postope rative nonfatal complications were seen in seven cases (7.5%). The overall median duration of chest tube drainage was 2.7 days and the mean postoperat ive hospital stay was 3 days. For diffuse lung disease, a tissue diagnosis was obtained in all the cases. Definitive diagnosis in the patients with un diagnosed pleural effusion was obtained in 90% of cases, and the overall di agnostic rate was 98.5%. The success rate of the therapeutic procedures was 100% after a mean follow-up of 12 months (range, 6-30 months). Conversion to thoracotomy was needed in six cases (6.6%). All patients scored postoper ative pain <50% according to the VAS. Video-assisted thoracoscopic surgery should be considered as a procedure of choice, with exceptional results in the following chest diseases: (a) undiagnosed pleural effusions; (b) recurr ent, post-traumatic, or complicated spontaneous pneumothorax; (c) stage II empyema; (d) accurate staging of lung cancer; (e) emergency traumatic injur ies of the chest; (f) peripheral solitary pulmonary nodule <3 cm; and (g) l ung biopsy for pulmonary diffuse disease.