Videoendoscopic procedures in thoracic surgery

Background: Current videoendoscopic technology and percutaneous techniques of exposure and dissection have been successfully applied to abdominal surgery with favourable results. Applications of this technology to our practice of thoracic surgery is the basis of this report. Methods: Video assisted thoracic surgery (VATS) has been performed in 43 patients for the following indications: Raynaud’s syndrome, undefined pulmonary nodule, persisting spontaneous pneumothorax, T1 bronchial carcinoma, and mediastinal cyst. Videoendoscopic surgical procedures were accomplished using double-lumen endotracheal anesthesia and a percutaneous stapling device. Procedures performed using this technique include thoracic sympathectomy, wedge or keel excision, blebectomy, lung apex stapling, parietal pleurectomy, and dissection of the mediastinal cyst. Results: Median operating time was 45 minutes (range, 15 to 90 minutes). Tissue diagnosis was obtained in all patients. Median diameter of excised nodules was 10 mm (range, 7 to 70 mm). There were no operative deaths. The 2 complications were prolonged air leaks after surgery of persistent pneumothorax, all patients left the hospital in excellent general condition. Conclusions: This new modality of thoracic surgery appears to have beneficial value for the patients. In our hands it proved as a secure way of doing thoracic surgery. Our case of removal of a benign cyst in the posterior mediastinum shows that video assisted thoracic surgery has expanding applications in the field of general thoracic surgery.