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Cardiothoracic Surgery |

Value of Video-Assisted Thoracoscopic Surgery (VATS) in the Diagnosis and Treatment of Mediastinal and Pleura-Pulmonary Diseases

Hamdy Mahmoud*, MD; Ayman Abdel Ghaffar, MD
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Sohag University-Sohag Faculty of Medicine, Sohag-Elmaragha-Nagecc Elhakim, Egypt


Chest. 2012;142(4_MeetingAbstracts):65A. doi:10.1378/chest.1367066
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Abstract

SESSION TYPE: Thoracic Surgery Posters II

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Thoracoscopy offers great advantages when compared with open surgery in terms of postoperative pain and pulmonary complications. Thoracoscopy is safe and feasible with minimal morbidity. The purpose of this study is to evaluate the indications, surgical procedures, complications, and failure rates of VATS in the diagnosis and treatment of intrathoracic diseases.

METHODS: One hundred seventy consecutive patients, 112 men and 58 women, with age ranging from 17 to 75 years (mean 45.7 years), underwent one hundreds seventy diagnostic, therapeutic and diagnostic & therapeutic VATS procedures. Indications included recurrent or persistent pneumothorax (n = 50 patients), empyema thoracis (20), solitary pulmonary nodules (23), diffuse lung disease (12), undiagnosed pleural effusions(40), mediastinal masses or cysts(20),bronchiectasis with hemoptysis(5).

RESULTS: Of the 170 VATS procedures, 157 (92.4%) procedures were successfully performed. Thirteen patients (7.6%) requried conversion to thoracotomy due to bleeding in 2 who had excision lung bleb, extensive adhesion in 2 with chronic empyema thoracis and unlocated lesion in 2 with solitary pulmonary nodule (SPN).There were 19 (11.2%) nonfatal postoperative complications: prolonged air leak for more than 5 days was seen in 8 patients. This complication occurred in 3 patients with spontaneous pneumothorax and 3 patients with empyema. Wound infection occurred in 3 patients. VATS in diagnostic procedures were effective in 91% (40 of 44 patients) and the procedures were 17 wedge excision for interstitial lung disease & (SPN), 19 pleural biopsies, and 8 biopsies for mediastinal tumors. Seventy five therapeutic procedures were effective in 70 patients (93.3 %) (71 of 75 patients).The success rate of the diagnostic & therapeutic procedures was 92.2% (47 of 51 patients) .Only small doses of analgesics were needed. There was no intraoperative mortality. The mean operative time was 71 minutes, The overall mean duration of chest tube drainage was 2.5 days and the average postoperative hospital stay was 5.1 days for successful VATS group.

CONCLUSIONS: VATS is a safe and effective method for diagnosis and treatment of intrathoracic diseases. Patients had benefit in reduced postoperative pain, short hospitalization, short recovery times and good cosmetic result.

CLINICAL IMPLICATIONS: VATS valuable is in diagnosis & treatment of lung, mediastinal & pleural lesions and spare patients hazard of thoracotomy.

DISCLOSURE: The following authors have nothing to disclose: Hamdy Mahmoud, Ayman Abdel ghaffar

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Sohag University-Sohag Faculty of Medicine, Sohag-Elmaragha-Nagecc Elhakim, Egypt

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