Thoracoscopic pulmonary surgery: indications and results.

OBJECTIVE

To report our experience of thoracoscopic pulmonary operations from May 1991 to May 1994.

DESIGN

Prospective open study.

SETTING

District hospital, Germany.

SUBJECTS

93 patients who underwent 120 thoracoscopic procedures.

INTERVENTIONS

Wedge resection (n = 56), pleural biopsy (n = 21), early decortication (n = 16), partial pleurectomy (n = 9), pleurodesis (n = 5), pulmonary biopsy (n = 4), segmentectomy (n = 3), evacuation of haemothorax (n = 3), biopsy of mediastinal tumor (n = 2), and costal biopsy (n = 1).

MAIN OUTCOME MEASURES

Morbidity, mortality, and avoidance of open thoracotomy.

RESULTS

Indications for thoracoscopic intervention were: solitary pulmonary nodule (n = 37), recurrent pneumothorax (n = 17), pleural empyema (n = 14), diffuse pulmonary disease/multiple nodules (n = 10), recurrent pleural effusion (n = 11), haemothorax (n = 3), and mediastinal tumour (n = 1). In 29 of 37 patients in whom we attempted resection of a solitary pulmonary nodule we obtained enough tissue for diagnosis, and avoided thoracotomy in 18 patients. Complications included pulmonary embolus (n = 1), recurrent empyema (n = 1), haemorrhage (n = 2), infection of the drain site (n = 3), and two persistent air leaks. One was closed at a second thoracoscopy and the other required open thoracotomy after which he developed pulmonary failure and died. One patient with a haemothorax developed multiple system organ failure and died, and attempted resection of a mediastinal tumour was unsuccessful. Three thoracoscopic procedures had to be abandoned because of dense adhesions.

CONCLUSIONS

Thoracoscopic surgery is a safe, well tolerated, and cost effective alternative to open thoracotomy in selected patients.