Video-assisted thoracoscopic surgery: experience with 341 cases

OBJECTIVE: Until recently, thoracoscopy had been used primarily for diagnostic purposes for more than 80 years in thoracic diseases. In this report we reviewed our video-assisted thoracoscopic surgery experience with 341 cases focusing on indications, operative procedures, complications or failure rates. PATIENTS AND METHODS: Over the last 3 years, we performed 459 video-assisted thoracoscopic procedures. There were 206 male and 135 female patients. RESULTS: The indications were diagnostic in 171 cases, and therapeutic in 170 cases. There were no operative mortality. Non-fatal complications were seen in 15 cases (4.4%). The mean postoperative stay was 5 days. The specific procedures performed were operations on the pleura (237 cases), lung (158 cases), mediastinum (56 cases) and pericardium (four cases). Conversion to thoracotomy was needed in 43 cases (12.6%). Definitive diagnosis was obtained in 100% of patients with pulmonary nodule/mass or diffuse lung disease, and 95.2% of patients with undiagnosed pleural effusions. The success rate of thoracoscopic approach in non-tuberculous thoracic empyema was 87.3%. CONCLUSIONS: Video-assisted thoracoscopic surgery is an ideal procedure in the following situations: (1) undiagnosed pleural effusion, (2) recurrent pneumothorax or bullous lung disease, (3) stage II thoracic empyema, (4) lung cancer staging, (5) peripheral pulmonary nodule, and (6) wedge biopsy for diffuse lung disease.