Video-Assisted Thoracic Surgical Procedures: The Mayo Experience

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Objective

To describe an initial 3-year experience with video-assisted thoracic surgical procedures (VATS) at Mayo at Mayo Clinic Rochester.

Design

We review the cumulative data on 771 VATS performed between June 1, 1991, and May 31, 1994, and assess the applications for this technique.

Material and Methods

The indications for VATS, our techniques used, and the associated mortality and morbidity are summarized. In addition, the frequency of conversion of VATS to open procedures and the reasons for choosing this strategy are discussed.

Results

The 771 study patients (401 male and 370 female patients) had a median age of 62 years (range, 7 to 96). For all VATS, we used one-lung general anesthesia, without carbon dioxide insufflation. Indications for performing VATS were a pulmonary nodule in 333 patients, pleural effusion in 208, pulmonary infiltrate in 117, pneumothorax in 51, mediastinal mass in 22, pleural mass in 17, air leak in 13, and other in 10. The procedure was a wedge excision in 352 patients, examination of the pleural cavity in 128, pleural biopsy in 86, talc pleurodesis in 85, wedge excision and mechanical pleurodesis in 46, decortication in 27, excision of a mediastinal mass in 12, sympathectomy in 4, and other in 16. The rate of conversion of VATS to thoracotomy was 33.1&x0025; and and did not change throughout the period of the study. The most common reasons for conversion were to complete a resection of a malignant lesion or to remove a deep nodule. The overall operative mortality was 1.9&x0025;. Complications occurred in 43 patients (8.3&x0025;) who underwent VATS without conversion to an open procedure and included prolonged air leak in 14, respiratory failure in 8, pneumothorax in 6, and atrial fibrillation in 5. The median hospitalization was 5 days (range, 1 to 104).

Conclusion

VATS is safe and useful for selected thoracic conditions. We favor conversion to thoracotomy when curative resection of a malignant lesion is intended.

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.

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