Department of Cardiothoracic Surgery, Odense University Hospital, 29 Sdr. Boulevard, 5000, Odense, Denmark.
World J Surg. 2010 Jul;34(7):1470-4. doi: 10.1007/s00268-010-0468-6.
Video-assisted thoracoscopic lobectomy was introduced in the early 1990s but has not yet gained widespread acceptance. The VATS approach is still controversial although several studies suggest less postoperative morbidity compared with open thoracotomy. Nevertheless, some patients report long-lasting chest wall pain following VATS procedures, and, in theory, such pain may be related to intercostal nerve injury. The present study presents our experience with a commercially available flexible thoracoscope.
The study was designed as a case-control series of prospectively collected data to determine if performing VATS with a flexible thorascope could have benefits for both the patient and the surgeon.
During the last 24 months 128 of 274 consecutive lobectomies (47%) were scheduled as VATS procedures with a new flexible high-definition thoracoscope. Six operations (4.6%) were converted to open surgery but only one case was converted during the last 12 months. There was no hospital mortality. The median duration of the operation was 105 min (range: 50-289 min), and the median postoperative hospital stay was 4 days (range: 2-27 days). At routine follow-up 2 weeks postoperatively all but three patients (2%) were considered pain free, which was significantly less than in 15 consecutive VATS lobectomies with rigid thoracoscopy performed prior to the introduction of flexible VATS (p = 0.02).
Video-assisted thoracoscopic lobectomy by flexible thoracoscopy is feasible and in our opinion easier and safer compared with rigid thoracoscopy. In our experience all parts of the operation are better visualized and many surgical pitfalls may be avoided. Even during early phases of setting up the VATS lobectomy program, the duration of the operation is comparable with open surgery, and postoperative pain is low, possibly because porthole angulation is minimized.
电视辅助胸腔镜肺叶切除术于 20 世纪 90 年代初引入，但尚未广泛普及。尽管一些研究表明与开胸手术相比，VATS 术后发病率较低，但这种方法仍存在争议。然而，一些患者在 VATS 手术后会出现长期的胸痛，并且理论上这种疼痛可能与肋间神经损伤有关。本研究介绍了我们使用市售的柔性胸腔镜的经验。
该研究设计为前瞻性收集数据的病例对照系列，以确定使用柔性胸腔镜进行 VATS 是否对患者和外科医生都有好处。
在过去的 24 个月中，274 例连续肺叶切除术中有 128 例（47%）计划作为 VATS 手术，使用新的柔性高清胸腔镜。有 6 例（4.6%）手术转为开胸手术，但仅在过去 12 个月中有 1 例转为开胸手术。无院内死亡。手术时间中位数为 105 分钟（范围：50-289 分钟），术后中位住院时间为 4 天（范围：2-27 天）。在常规术后 2 周随访时，除 3 例（2%）患者外，所有患者均被认为无疼痛，这明显少于在引入柔性 VATS 之前连续进行的 15 例刚性胸腔镜 VATS 肺叶切除术（p = 0.02）。
通过柔性胸腔镜进行电视辅助胸腔镜肺叶切除术是可行的，并且在我们看来，与刚性胸腔镜相比，该手术更容易且更安全。根据我们的经验，手术的各个部分都能更好地可视化，并且可以避免许多手术陷阱。即使在建立 VATS 肺叶切除术计划的早期阶段，手术时间也可与开胸手术相媲美，并且术后疼痛较低，这可能是因为端口角度最小化了。
