PURPOSE: Video-assisted thoracoscopy (VATS) has become widely accepted for pulmonary procedures. Another approach is median sternotomy (MS). Both VATS and MS are suggested to be superior to thoracotomy regarding pain, morbidity, hospital stay, and costs. VATS and MS are routine for lung volume reduction surgery (LVRS) and have been shown to be similar in regard to post operative outcomes. Few, if any, trials have been conducted to determine which procedure offers less pain. We wished to compare pain and postoperative complications in VATS vs MS for bilateral lung volume reduction surgery.
METHODS: This prospective, non-randomized study contained 85 LVRS patients: 23 MS and 62 bilateral VATS. Pain was measured pre-operatively and post-operatively using the Visual Analogue Scale (VAS) and Brief Pain Inventory (BPI). Incentive spirometry (IS) assessed restriction of the thoracic cage due to pain. We compared complications, medication usage, hospital stay, operating times, and chest tube duration.
RESULTS: Demographically, the two groups were similar. More males underwent MS than females (p=.035). Operating times were longer for VATS (109+39.6 minutes versus 81.6+32.1 minutes, p=.023). IS changes from baseline through follow-up were similar between groups. VAS and BPI scores revealed no difference in postoperative pain except for VAS scores on days 6 and 7 (day 6 VATS 2.30 versus MS 4.29, p=.007 and day 7 VATS 2.15 versus MS 3.8, p=.032). There were inverse correlations between IS and pain or activity through 1 month but no correlations existed at 3 months or beyond. Chest tube duration and complications were similar between groups. Tramadol use was greater on days 5 (291.7 ± 111.4 vs 144.7 ± 84.8 mg, p=.002) and 6 (301.7 ± 119.2 vs 196.67 ± 177.8mg, p=.012) for MS patients.
CONCLUSION: Our study suggests that VATS and MS offer similar outcomes in the aspects of pain and complications.
CLINICAL IMPLICATIONS: Study findings will aid surgeons in choice of surgical approach and be helpful in counseling patients preparing for surgery via mediansternotomy or bilateral thoracoscopy.
DISCLOSURE: Theresa Boley, No Financial Disclosure Information; No Product/Research Disclosure Information