Thoracoscopic lobectomy for benign disease - a single centre study on 64 cases

Objective: Chronic lung infection is the main indication for lobectomy in b enign pulmonary disease and may be technically demanding due to inflammator y changes such as adhesions, lymph node enlargement and neovascularization. The role of the thoracoscopic operation in these indications is yet ill-de fined. Methods: We retrospectively analyzed the results of patients who und erwent thoracoscopic lobectomy (TL) between 1992 and June 1999 and compared this study group with patients who underwent open lobectomy (OL), all for benign disease. Data were not normally distributed, therefore, the median a nd range is given and nonparametric statistical analysis was applied. Resul ts: A total of 117 lobectomies for benign disease (64 TL) were analyzed. In dications included bronchiectasis (36 TL; 18 OL), chronic infections (13 TL ; eight OL), tuberculosis (five TL; 15 OL), emphysema (five TL; one OL), AV -malformations (two TL; one OL), severe haemoptysis (four OL), and others ( three TL; six OL). Twelve conversions to thoracotomy were necessary due to severe adhesions. One patient in the open lobectomy group died within 30 da ys postoperative. Drainage time was 5.0 (1-32) days in TL and 6.0 (3-21) da ys in OL, hospital stay was 8.5 (4-41) days and 10.0 (5-52) days, respectiv ely. Blood loss was 0 (0-2000) ml in TL and 300 (0-6000) ml in OL. Operatio n time for thoracoscopic lobectomies significantly decreased from 2.5 (1-6) h for cases between 1992 and 1997 (n = 49) to 1.5 (0.5-2.5) h for recent c ases (n = 15) (P < 0.01). In addition, a trend towards less blood loss was noted (100 (0-2000) ml vs. 0 (0-400) ml; P = 0.06). Drainage time and hospi tal stay did not differ significantly. Conclusions: Thoracoscopic lobectomy in chronic inflammatory disease can be performed safely in selected patien ts, especially with bronchiectasis. Conversion rate to thoracotomy is low. Operation time with this approach declined significantly over time. (C) 200 1 Elsevier Science B.V. All rights reserved.