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The Journal of Cardiovascular Surgery 1999 August;40(4):597-601

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

A standard muscle-sparing utility thoracotomy for vats procedures

Spaggiari L., Carbognani P., Solli P., Rusca M.

From the Department of General Thoracic and Vascular Surgery University of Parma, Parma, Italy


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Back­grounds. Improve­ments in sur­gical equip­ment ­have ren­dered ­video-­assisted tho­racic sur­gery (­VATS) an effec­tive ­device for tho­racic sur­geons and now­a­days sev­eral intra­tho­racic dis­eases can ben­efit ­from ­this ­approach. ­This devel­op­ment has ­expanded poten­tial use and ­recently the tech­nical fea­sibility of ­major ­lung resec­tions by ­VATS has ­been dem­on­strated. The ­authors ­present ­their expe­ri­ence ­with a stan­dard ­muscle-­sparing ­utility thor­a­cotomy (UT) uti­lized for all ­VATS pro­ce­dures, ­including ­major ­lung resec­tions.
­Methods. ­From ­November 1996 to ­October 1997, 30 ­patients ­were oper­ated on. ­There ­were 22 ­males and 8 ­females (­medium age 58 ­years; ­range 24-78). ­There ­were 13 ana­tom­ical ­lung resec­tions (i.e.: 11 lobec­to­mies, 1 ­left pneu­mo­nec­tomy, 1 seg­mental resec­tion), 8 ­wedge resec­tions, 3 ­lung ­biopsies, 2 debride­ments of ­pleural ­empyema, 2 med­i­as­tinal ­nodes ­biopsies, 1 esoph­a­geal resec­tion for leiom­yoma, 1 exci­sion of ­benign med­i­as­tinal ­cyst.
­Results. No mor­tality or ­major mor­bidity ­were ­recorded, as ­well as no rib frac­tures due to the rib ­spreader. Two ­patients suf­fered ­from pro­longed air-­leaks ­after respec­tively ­left ­upper lobec­tomy and ­lung ­biopsy and ­required pro­longed ­chest ­drainage. Con­cerning ana­tomic ­major ­lung resec­tions the ­medium hos­pital ­stay was 7.9 ­days and ­medium ­chest ­tube ­time was 5.6 ­days. The ­utility thor­a­cotomy ­through the aus­cul­ta­tory tri­angle ­proved to be a ­safe ­approach and con­firmed the tech­nical fea­sibility of var­ious ­type of sur­gical pro­ce­dures ­with ­results com­par­able to stan­dard ­open thor­a­cotomy. Our ­data ­shows ­that ­VATS ­approach did not seri­ously ­affect the dura­tion of hos­pital ­stay, ­chest ­tube ­time, the ­overall mor­bidity or ­lung func­tion.
Con­clu­sions. As the ­real ben­efit of ­this ­approach ­remains con­tro­ver­sial, the ­majority of the ­studies com­paring the ­VATS ­approach to con­ven­tional ­muscle-­sparing thor­a­cotomy nei­ther nor pros­pec­tive nor ran­dom­ized, and sev­eral param­e­ters are dif­fi­cult to eval­uate in the lit­er­a­ture fur­ther ­study are man­da­tory.

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