Video-assisted thoracic surgery: experience with 126 cases.

VATS was performed in 126 patients at the Medical Center of Delaware from December 1991 to August 1993, with no major complications and no mortality. A definitive diagnosis was made in all cases. Results with VATS therapeutic procedures appear to equal those of the standard open technique. Operating time was comparable to that with the open technique. Length of stay and pain and suffering were dramatically reduced when compared with those associated with the open technique. We now consider VATS to be the preferred procedure in cases of: 1. Undiagnosed pulmonary infiltrate in the nonventilator-dependent patient 2. Indeterminate pulmonary nodule 3. Undiagnosed disease of the pleural space 4. Recurrent or persistent pneumothorax 5. Mediastinal or pericardial cystic tumors 6. Thoracic sympathectomy 7. Selected patients requiring esophagocardiomyotomy. The utilization of VATS for resection of a pulmonary mass in patients with cardiopulmonary compromise (i.e., FEV < 1) is being studied. Further development of this technique and expansion to formal pulmonary resection and cardiovascular procedures must follow the philosophy presented in our conclusion. The place of VATS in the management of penetrating thoracic trauma has been studied at several centers, with excellent results when precise guidelines have been followed. Obviously, one-lung anesthesia is not well tolerated when a patient is in profound shock, but if the patient can be stabilized before thoracotomy, the introduction of a camera to diagnose a carotid or internal mammary artery laceration or to staple an easily accessible pulmonary tear could obviate the need for a thoracotomy and its consequences for the patient. Again, as in all surgical operations, common sense and good judgment must prevail.