Search

The application of video-assisted thoracic surgery (VATS) for major lung resection is controversial. We review our combined experience from three centers in Asia. From June 1993 through June 1997, 214 patients underwent VATS major resections (2 segmentectomies, 203 lobectomies, 6 bilobectomies, 3 pneumonectomies), mostly for primary malignancy. Stringent selection criteria were used to choose patients for this approach. We prefer a technique of not spreading ribs, using conventional thoracic instrument for dissection and routine use of wound protector for specimen retrieval. There was one postoperative surgical death and 47 non-fatal complications, which compare favorably with published series on open technique. Of the primary lung cancer patients, 93% are still alive after a mean follow-up of 26 months. We conclude that VATS major lung resection is technically feasible in selected patients and associated with favorable intermediate-term results.

Background: Within a short period of time, video assisted thoracoscopic surgery (VATS) has revolutionised the practice of thoracic surgery. Most of the existing literature, however, is concentrated on the technical aspects., Aims: We examined the impact of VATS on our practice and its implications., Methods: We reviewed our thoracic case load two years before and two years after the introduction of VATS in our hospital., Results: We have witnessed a rapid and progressive increase in our thoracic case load since the introduction of VATS. With increased experience, proportionally more cases were performed using VATS compared to conventional surgical access. The increased case load covered a wide range of thoracic diseases with the majority for spontaneous pneumothorax and pleural diseases., Conclusions: The higher case load is due to increased referrals which at least partly reflect earlier acceptance by both the patients and their physicians for surgical intervention. The changing indications for surgery and the high cost associated with VATS, however, could place extra demand on the healthcare, especially for some countries in Asia. Cost containment is therefore a high priority here. More research is greatly needed in this area.