Intrathoracic biopsies, pulmonary wedge excision, and management of pleural disease: is video-assisted closed chest surgery the approach of choice?

Few studies define differences between video-assisted thoracic surgery (VATS) over conventional posterolateral thoracotomy (PLT) for limited procedures. We propose that length of hospital stay (LOS), the days of requirement for narcotic analgesia (DNA) by epidural, intravenous, intramuscular, or oral administration, operating time (OT), return to pre-operative functional status (RT), and the achievement of a therapeutic objective are not dependent on the approach taken (VATS or PLT) for selected diagnostic and therapeutic procedures for pleural, pulmonary, or mediastinal disease. A total of 102 consecutive patients (52 males, 50 females, age 48 +/- 16 years) were eligible to undergo (VATS) for diagnosis and/or treatment of lung lesions, pleural disease, persistent pneumothorax or mediastinal lesions. Seventy-two underwent VATS only and 21, conventional posterolateral thoracotomy (PLT). Nine VATS patients were converted to PLT, for completion of lobectomies after VATS staging of resectable malignancy (6), extensive decortication (2), and giant bullectomy (1). VATS and PLT were compared according to OT, LOS, DNA, RT, achievement of diagnostic and/or therapeutic objective, and morbidity and mortality. After VATS only and PLT only, LOS was 4.8 +/- 2.7 and 7.8 +/- 4.6 days, respectively (P < .03). DNA was 3.4 +/- 2.1 and 6.1 +/- 3.6 days after surgery, respectively (P < .01). RT was 12.0 +/- 11.2 and 21.4 +/- 9.5 days, respectively (P < .01). OT was 80 +/- 34 and 95 +/- 32 minutes, respectively (P = ns). Among 9 conversions from VATS to PLT LOS was 11.4 +/- 5.5, DNA 6.9 +/- 4.4 and RT 20.1 +/- 6.0 days.(ABSTRACT TRUNCATED AT 250 WORDS)