Summary
Background: Thoracoscopy has been used throughout this century, especially in the treatment of pleural disease. The introduction of video-assistance and especially designed instruments such as stapling devices in 1992 led to a worldwide and enthusiastic application for the treatment of a variety of thoracic pathologies.
Methods: This report summarizes our experience gained from 1013 consecutive VATS procedures performed since 1990 for various indications in order to clarify its role for surgery of thoracic pathologies.
Results: 234 patients underwent VATS for pleural biopsy, 154 for talcage, 163 for pulmonary wedge resections in order to clarify interstitial diseasee or indetermined nodules, 126 for spontaneous pneumothorax, 91 for decortication of empyema, 63 for symphatectomy, 55 for biopsy of mediastinal lesions, 29 for pericardial effusions (fenestration), 25 for lung volume reduction surgery, 17 for excision of mediastinal cysts and 12 for excision of neurogenic tumors of the posterior mediastinum.
Conclusions: Our results demonstrate that VATS has gained established acceptance for several indications, however, caution in application of VATS is clearly indicated for some diseases, especially for thoracic malignancies.
Zusammenfassung
Grundlagen: Thorakoskopische Interventionen werden seit Beginn dieses Jahrhunderts durchgeführt, insbesondere zur Diagnostik und Therapie pleuraler Erkrankungen. Die Einführung der Videothorakoskopie sowie der endoskopischen Klammernähapparate 1992 hat zu einer enthusiastischen Verbreitung dieser Methode zur Behandlung einer Vielzahl von thorakalen Pathologien geführt.
Methodik: In dieser Studie wird unsere Erfahrung anhand von seit 1990 an unserer Institution durchgeführten, 1013 konsekutiven Thorakoskopien hinsichtlich Indikation und Resultate dargestellt, um die Rolle der Videothoraskoskopie für verschiedenste thorakale Pathologien klarer zu definieren.
Ergebnisse: 234 Patienten wurden mittels videoassistierter Thorakoskopie pleurabiopsiert, in 154 Patienten erfolgte eine Talkpleurodese, in 163 eine Lungenkeilresektion im Hinblick auf eine offene Lungenbiopsie oder zur histologischen Aufarbeitung eines peripheren Rundherdes, in 126 die thorakoskopische Behandlung eines Spontanpneumothorax, in 91 die Dekortikation eines pleuralen Empyems, in 63 eine thorakale Sympathektomie, in 55 eine Lungenvolumenreduktionstherapie, in 29 Patienten eine Perikardfenestration, in 17 die Exzision von mediastinalen Zysten und in 12 eine Exzision von neurogenen Tumoren des posterioren Mediastinums.
Schlußfolgerungen: Unsere Resultate zeigen, daß die videoassistierte Thorakoskopie mittlerweile ein klar akzeptiertes Verfahren hinsichtlich verschiedener Indikationen darstellt, während bei anderen Indikationsstellungen, insbesondere bei Malignomen im Thoraxbereich, die Rolle der Thorakoskopie noch ungenügend geklärt ist.
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Ris, H.B., Lardinois, D. & Gugger, M. Video-assisted thoracic surgery: Risks and benefits. Acta Chir Austriaca 31, 286–291 (1999). https://doi.org/10.1007/BF02619928
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DOI: https://doi.org/10.1007/BF02619928