Video-assisted thoracoscopic surgery (VATS) in the diagnosis and treatment of intrathoracic diseases at Ratchaburi Hospital.

OBJECTIVE: To review the authors' experience and benefit in diagnosis and management of intrathoracic diseases by Video-assisted thoracoscopic surgical procedures (VATS) using a non trocar technique.

MATERIAL AND METHOD: Retrospective review of sixty-eight consecutive patients who underwent seventy-one VATS procedures between January 1997 and December 2004. Indications included recurrent or persistent pneumothorax (n = 21 patients), empyema thoracis (17), lung nodules or masses (8), clot haemothorax (6), pleural effusion (4), pleural thickening or masses (3), mediastinal masses or cysts (3), pericardial effusion (2), removal of bullets from the pleural cavity (2), bronchiectasis with hemoptysis (1) and inspection of diaphragmatic injury (1) (Table. 1). An alternative method of manipulating thoracoscopic instruments without using a trocar was described.

RESULTS: Of the 71 VATS procedures in 68 patients, 62 (87.3%) procedures were successfully performed in 59 patients. Three of them underwent VATS bilaterally. (1 Tuberculous empyema and 2 spontaneous pneumothorax). Four patients requried conversion to thoracotomy due to bleeding in 1 who had excision lung bleb, extensive adhesion in 2 with chronic empyema thoracis and unlocated lesion in 1 with solitary pulmonary nodule (SPN). There were 5 postoperative complications: prolonged air leak for more than 7 days was seen in 4 patients. This complication occurred in a patient with spontaneous pneumothorax (3 patients) and bilateral tuberculous empyema at the left side (1 patient). Wound infection and mild effusion occurred in 1 patient with unilateral tuberculous empyema (no additional drainage was required). VATS in diagnostic procedures were effective in 90% (9 of 10 patients) and the procedures were 4 wedge excision, 3 pleural biopsies, 1 wedge excision for interstitial lung disease 1 inspection of diaphragmatic injury and 1 required conversion. Sixty one therapeutic procedures were effective in 50 patients (85.9%) (50 of 58 patients). None of them had a recurrence of pneumothorax after VATS procedures or other complications. Only small doses of analgesics were needed. There was no intraoperative mortality. The mean operative time was 67 minutes and the average postoperative hospital stay was 5.4 days for successful VATS group.

CONCLUSION: VATS using of a non-trocar technique is a safe and effective method for diagnosis and treatment of intrathoracic diseases. Patients had benefit in reduced postoperative pain, short hospitalization, short recovery times and good cosmetic result.