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The safety and versatility of video-thoracoscopy: a prospective analysis of 895 consecutive cases.

Publication ,  Journal Article
DeCamp, MM; Jaklitsch, MT; Mentzer, SJ; Harpole, DH; Sugarbaker, DJ
Published in: J Am Coll Surg
August 1995

BACKGROUND: The application of video-endoscopy to general thoracic surgery is radically changing the approach to many benign and malignant diseases of the chest. Since July 1991, we have performed 794 purely thoracoscopic and 101 video-assisted thoracic surgical (VATS) procedures on 860 patients. STUDY DESIGN: Comprehensive, prospectively acquired data examining the specific indications for and outcomes of this new technique were prospectively entered into a thoracic surgical database. Preoperative, intraoperative, postoperative, and outcome variables were studied for the entire group as well as three high-risk cohorts: age over 70 years (n = 198), forced expiratory volume in one second (FEV1) of less than 1 L (n = 46), and Karnofsky performance index of less than 8 (n = 61). RESULTS: The 895 cases involved 449 men and 446 women of ages 15 to 89 years (mean 56 +/- 16 years standard deviation). The indications for surgery were diagnostic in 501 cases (56 percent), therapeutic in 244 cases (27 percent), and both diagnostic and therapeutic in an additional 150 cases (17 percent). The specific procedures performed were operations on the lung (569 cases), pleura (196 cases), esophagus (42 cases), mediastinum (51 cases), and pericardium (37 cases). Fifty-seven percent of the procedures were for a malignant process and 43 percent were for benign or infectious pathology. There were nine deaths for a series operative mortality rate of 1.0 percent. Thirteen patients (1.4 percent) required conversion to a limited thoracotomy for technical reasons. There were 127 complications in 121 patients yielding a morbidity rate in all patients of 14 percent. Mortality rates in the elderly, poor lung function, and depressed performance index cohorts were 1.5, 2.1, and 9.8 percent, respectively. Morbidity rates in these high-risk populations were 19, 30, and 18 percent, respectively. The median postoperative length of stay was three days after closed thoracoscopy and five days after VATS resection. CONCLUSIONS: These data underscore the flexibility, safety, efficacy, and potential for cost savings of videoscopic surgery in patients with thoracic diseases. The ability to perform excisional biopsy improves diagnostic specificity and sensitivity to nearly 100 percent. Video-assisted thoracic surgical techniques also offer a minimally invasive procedure with acceptable risk to patients heretofore inoperable by standard thoracotomy.

Duke Scholars

Published In

J Am Coll Surg

ISSN

1072-7515

Publication Date

August 1995

Volume

181

Issue

2

Start / End Page

113 / 120

Location

United States

Related Subject Headings

  • Video Recording
  • Treatment Outcome
  • Thoracotomy
  • Thoracoscopy
  • Thoracic Surgery
  • Survival Rate
  • Surgery
  • Safety
  • Risk Factors
  • Prospective Studies
 

Citation

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DeCamp, M. M., Jaklitsch, M. T., Mentzer, S. J., Harpole, D. H., & Sugarbaker, D. J. (1995). The safety and versatility of video-thoracoscopy: a prospective analysis of 895 consecutive cases. J Am Coll Surg, 181(2), 113–120.
DeCamp, M. M., M. T. Jaklitsch, S. J. Mentzer, D. H. Harpole, and D. J. Sugarbaker. “The safety and versatility of video-thoracoscopy: a prospective analysis of 895 consecutive cases.J Am Coll Surg 181, no. 2 (August 1995): 113–20.
DeCamp MM, Jaklitsch MT, Mentzer SJ, Harpole DH, Sugarbaker DJ. The safety and versatility of video-thoracoscopy: a prospective analysis of 895 consecutive cases. J Am Coll Surg. 1995 Aug;181(2):113–20.
DeCamp, M. M., et al. “The safety and versatility of video-thoracoscopy: a prospective analysis of 895 consecutive cases.J Am Coll Surg, vol. 181, no. 2, Aug. 1995, pp. 113–20.
DeCamp MM, Jaklitsch MT, Mentzer SJ, Harpole DH, Sugarbaker DJ. The safety and versatility of video-thoracoscopy: a prospective analysis of 895 consecutive cases. J Am Coll Surg. 1995 Aug;181(2):113–120.
Journal cover image

Published In

J Am Coll Surg

ISSN

1072-7515

Publication Date

August 1995

Volume

181

Issue

2

Start / End Page

113 / 120

Location

United States

Related Subject Headings

  • Video Recording
  • Treatment Outcome
  • Thoracotomy
  • Thoracoscopy
  • Thoracic Surgery
  • Survival Rate
  • Surgery
  • Safety
  • Risk Factors
  • Prospective Studies