Prerequisites, Indications, and Techniques of Video-assisted Thoracoscopic Surgery

Abstract

During the last two years video-assisted operative thoracoscopy has introduced new impetus into thoracic surgery. Today it is viewed as a sparing and safe alternative to thoracotomy for a wide spectrum of indications. The prerequisites, instruments, and operative techniques are discussed. In oncological thoracic surgery it still remains to be verified whether the criteria of radicality are fulfilled by this new technique. Using video-assisted operative thoracoscopy, we have successfully operated on 209 patients with the following indications: recurrent pneumothorax (n = 94), interstitial lung disease (n = 25), coin lesion (n = 20), pleural effusion (n = 17), hyperhidrosis (n = 14), mediastinal tumor or lymphoma (n = 10), thoracic empyema (n = 9), bullous emphysema (n = 8), pleural tumor (n = 5), hematothorax (n = 3), malignant pericardial effusion (n = 3), and chylothorax (n = 1). The advantages of this minimally traumatizing operating technique lie in a better view of the operative site, the objectively measurable reduction in postoperative restriction, less pain, earlier postoperative mobilization, and shorter hospital stay. This operating technique, in addition to being sparing, requires markedly less time than a thoracotomy. The disadvantages are the two-dimensional monitor picture and, especially, the loss of palpation.

Video-assisted Thoracoscopic Surgery - Indications, Results, Complications, and Contraindications

“…Video-a ssisted thoracoscopi c surge ry is no more stressful than diagnostic thoracoscopy. Hemoving the pari etal pleura is alm ost completely possible (27). It is low in risk and even success ful for encapsulated effusions so that, in our view, it should be preferred to imprecise me dica me ntous pleurodesis a nd is the the rapy of choice for patients in good general condition.…”

“…34). Technica lly it is poss ible to con duct it acc ept abl y ra pidly without d ifficulty (27), wh er eby the tota l operaton time is exte nded by a thir d to 88 minu tes compared to pleu ral a brasion, which we nevertheless still consider quite sa tisfactory (31 ).…”

“…which improv es visibility during rese ction. Smaller bladders sh ould be treated by laser coa gulatio n (27). Lung cysts ca n be removed from the pulmonary parenchyma after first securing primary air tightness of the resection borders.…”

Manejo de quilotórax posquirúrgico: Clipaje del conducto torácico y derivación pleuroperitoneal por toracoscopia

“…Actualmente, según el gasto diario de quilo por el drenaje torácico, se maneja conservadoramente o sometiendo a una intervención quirúrgica temprana con la cirugía torácica vídeoasistida, conocida como VATS (video-assisted thoracic surgery), ligando o clipando el conducto torácico ( 1 ). La VATS permite una visión magnificada de las estructuras torácicas, es mínimamente invasivo, de rápida recuperación posquirúrgica y alta temprana ( 1,[6][7][8] ). Respaldado por nuestra revisión en la literatura médica, comunicamos el primer caso de quilotórax posquirúrgico de una cirugía torácica por hidatidosis pulmonar gigante, que fue tratada exitosamente mediante el clipaje del conducto torácico y una derivación pleuroperitoneal ( 9 ) por VATS.…”

Der videoassistiert-thoracoskopische Zugang zum Pleuraempyem im Vergleich zu Drainagetherapie oder Thoracotomie

“…Unsere Technik der VAT wurde andernorts beschrieben [4,11,13] und entspricht im wesentlichen der Technik anderer Zentren [15]. Besonderen Wert legen wir auf die Auslösung der gesamten Lunge, die intraoperative Spülung mit ca.…”