Video-Assisted Thoracic Surgical Procedures: The Mayo Experience
Section snippets
Material And Methods
Between June 1, 1991, and May 31, 1994,771 VATS were performed at Mayo Clinic Rochester. This number represents 16.1&x0025;&x00A0;of all general thoracic surgical procedures performed during that period. The 401 male and 370 female patients had a median age of 62 years (range, 7 to 96). The indications for VATS are listed in Table 1. The most common indication was resection of a pulmonary nodule, which was undertaken in 333 patients (43.2&x0025;). Pleural effusions, pulmonary infiltrates, and
Results
The types of procedures performed are summarized in Table 2. In 15 patients (1.9&x0025;), the pleural space was fused, and a VATS was not possible. Wedge excision was the most common procedure; it was performed in 45.7&x0025; of the 771 patients. In the 128 patients (16.6&x0025;) listed as having an examination only, once the thoracoscope had been placed, performance of the procedure either was unnecessary or necessitated a thoracotomy. Pleural biopsy was performed in 86 patients (11.2&x0025;),
Discussion
When VATS was introduced in 1991, some predicted that it would replace traditional thoracic surgical procedures. Clearly, this trend has not occurred. Our experience reveals that thoracoscopy is a safe procedure but has limited applications. Although it is useful for diagnosis, its use for treatment of malignant lesions is limited. The reduced visibility with use of this technique can lead to inadequate resection of malignant disease. As our experience shows, however, VATS is useful for
Conclusion
Since the beginning of VATS in 1991, the equipment, indications, and procedures have been evolving. Obviously, the decision of how to perform a procedure must be individualized for each patient. VATS have proved to be effective for diagnosing a small peripheral nodule, biopsying the pleura, performing talc pleurodesis, and treating a spontaneous pneumothorax. We have attempted to incorporate VATS into the armamentarium of our general thoracic surgical practice. Just as for many other
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Current address: University of Iowa College of Medicine, Iowa City, Iowa.