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This survey addressed common methods of video-assisted thoracoscopic pleurodesis for spontaneous pneumothorax. A questionnaire asking for frequency, recurrence rate and complications of the different methods of pleurodesis was sent to all hospitals that belong to the German Society for Thoracic Surgery. 19 hospitals reported on a total of 1365 operations. 88 recurrences (6.5%), 26 severe bleeding complications (1.9%), 39 persisting air leaks (2.9%) and two hospital deaths (0.1%) had been observed. Pleurectomy and pleural abrasion were the most common procedures but induced significant (p = 0.01) more bleeding complications (3.1% and 2.6%) than all other methods of pleurodesis (0.4%). Overall recurrence rates depended significantly on the chosen procedure (p = 0.0013). Pleurectomy (4.4%) and coagulation of the pleura (2.7%) showed better results than the average. Due to smaller numbers of operations and the widely differing results this significance cannot be shown for the individual recurrence rates of the different clinics. This survey demonstrated a trend towards lower rates of recurrence and complications after coagulation of the pleura parietalis. The retrospective character of the investigation and extremely different recurrence rates for different hospitals demand cautious interpretation of these results.

With the further development of new surgical techniques, that allow for the performance of a variety of standard diagnostic and therapeutic procedures in a less invasive fashion, it is instructive to look at the complications of these new techniques, in order to define their role for general thoracic surgery. 372 patients have been treated by means of video-assisted thoracic surgery (VATS) between 1/1992 and 12/1994. A total of 934 open thoracic procedures were performed in the same time frame, 399 out of them for the same chest disorders as treated by VATS alternatively. In 40 cases (10.7%) the endoscopic procedure had to be converted to an open thoracotomy. The main reasons for conversion were inability to locate or resect lesions due to a deep or central position (n = 13), requirement of further resection (n = 10), adhesions (n = 9), fibrinopurulent empyema (n = 5), bleeding (n = 2) and single-lung-ventilation failure (n = 1). The mean operation time was significantly shorter with VATS compared to open procedures, except for decortications. The mean hospital stay was 4.2 days in the endoscopic and 7.9 days in the thoracotomy group. Cost analysis for both techniques included expenses for disposable instruments, the operation room, anesthesia, and total hospital charges. Higher costs for instruments for VATS procedures were compensated by shorter chest drainage, less postoperative need for analgetics and a significantly shorter hospital stay.(ABSTRACT TRUNCATED AT 250 WORDS)

His extensive developmental and clinical work made Raimund Wittmoser a major trailblazer in endoscopic surgery from the 1950s on. His single-puncture technique for operative thoracoscopy permitted surgical interventions of peerless quality on the sympathetic and vagal nerves. His basic surgical principle was to achieve the greatest possible selectivity by a segmental approach to the sympathetic rami communicantes or the individual branches of the vagus nerve. Besides his extraordinary surgical skills, his particular achievement was the development of new instrumental and ancillary technologies for endoscopic surgery. In addition to the development of new endoscopes and imaging systems, his pressure-regulated CO2 insufflation system and low frequency cautery technique had major impact on the further development of endoscopic surgery. Finally, Wittmoser's surgical interventions in the autonomic nervous system were of outstanding quality and set standards still observed by thoracoscopic surgeons today.