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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 2000 Ottobre;41(5):767-71

lingua: Inglese

Usefulness of thoracoscopic surgery in the diagnosis and management of thoracic diseases

Petrakis I., Katsamouris A., Drossitis I., Bouros D., Chalkiadakis G.

From the Division of Thoracic Surgery University Hospital of Herakleion University Medical School of Herakleion University of Crete, Greece


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Background. Video-assist­ed tho­rac­os­cop­ic sur­gery (­VATS) has ­been recent­ly util­ised in the diag­no­sis and man­age­ment of tho­rac­ic dis­eas­es. In ­this arti­cle we ­report our ­series of ­patients ­with estab­lished indi­ca­tions for ­VATS treat­ment.
Methods. Over the ­past 6 ­years we per­formed 104 ­VATS pro­ce­dures for diag­nos­tic and ther­a­peu­tic pur­pos­es in 95 men and 39 wom­en. The spe­cif­ic indi­ca­tions for ­VATS ­were: ­lung biop­sy for undi­ag­nosed dif­fuse ­lung dis­ease, med­i­as­ti­nal biop­sy and ­cysts, pleu­ral effu­sion, empye­ma, pneu­moth­o­rax and bul­lous ­lung dis­ease, per­i­car­dial effu­sion and ­cyst, par­ver­te­bral ­abscess and sol­i­tary pul­mo­nary nod­ules.
Results. There was no oper­a­tive mor­tal­ity. Posto-per­a­tive non-­fatal com­pli­ca­tions ­were ­seen in 7 cas­es. The over­all ­median dura­tion of ­chest ­tube drain­age was 2.5 ­days and the ­mean post­op­er­a­tive ­stay 3 ­days. In dif­fuse ­lung dis­ease a tis­sue diag­no­sis was ­obtained in all cas­es. Definitive diag­no­sis in the ­patients ­with undi­ag­nosed pleu­ral effu­sion was ­obtained in 90% of cas­es and the over­all diag­nos­tic ­rate was 98.5%. The suc­cess ­rate of the empye­ma (stage II) treat­ment and the ther­a­peu­tic pro­ce­dures is 100% ­after a ­mean fol­low-up of 12 ­months (­range 6-30). Conversion to thor­a­cot­o­my was need­ed in 6 cas­es. In all ­patients the post­op­er­a­tive ­pain was con­trolled ­with ­intake of non-nar­cot­ic anal­ge­sics ­with sat­is­fac­to­ry ­results.
Conclusions. ­VATS is ­worth con­sid­er­ing and has ­been estab­lished as pro­ce­dure of ­choice, ­with excep­tion­al ­results in var­i­ous ­chest dis­eases ­such as undi­ag­nosed pleu­ral effu­sions, recur­rent, ­post-trau­mat­ic or com­pli­cat­ed spon­ta­ne­ous pneu­moth­o­rax, ­stage II empye­ma, accu­rate stag­ing for ­lung can­cer in the resec­tion of periph­er­al sol­i­tary pul­mo­nary nod­ule ­less ­than 3 cm, and ­lung biop­sy for pul­mo­nary dif­fuse dis­ease.

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