Role Of Video-assisted Thoracic Surgery Research Articles

Role of Video Assisted Thoracoscopic Surgery (VATS) in the Management of Pulmonary Sequestration; A Meta-Analysis

Background: Pulmonary sequestration is a rare birth defect. It is a nonfunctioning dysplastic lung tissue without connection to the tracheobronchial tree, and its blood supply is from one or more aberrant systemic arteries. The aim of this study is to review the current literature regarding the role of video-assisted thoracic surgery (VATS) in the management of pulmonary sequestration. Objective: This review aims to assess the safety, efficacy, and outcomes of Video-Assisted Thoracoscopic Surgery (VATS) in managing pulmonary sequestration while considering patient characteristics, symptoms, arterial sources, surgical techniques, and postoperative advantages. Methods: The Web of Science, PubMed, MEDLINE, and Google Scholar were searched for articles published in English. Article titles containing the words “Video-Assisted Thoracoscopic Surgery for Pulmonary Sequestration and/or VATS” were filtered out of the search to exclude a large portion of irrelevant studies. The extracted data were analyzed. The data extracted were presented as frequencies and percentages. Results: After excluding the unrelated articles, 27 studies were identified for analysis; most of the studies (18) were case reports, with nine being case series, and the total number of patients who underwent pulmonary sequestration by VATS was 240. Both genders were equally affected (125, 52% were male and 115, 48% were female), the most common presenting symptom was coughing,and the descending thoracic aorta was the most common artery from which the feeders originated. About 149 patients (62.08%) underwent a lobectomy. Conclusion: Pulmonary sequestration can safely be treated by VATS at single or multiple ports with a shorter hospital stay, less postoperative pain, and fewer analgesic requirements.

Surgical repairment of traumatic rib fractures and the role of video-assisted thoracic surgery

Surgical repairment of traumatic rib fractures and the role of video-assisted thoracic surgery

Role of video-assisted thoracic surgery in T4 NSCLC

: For many years, T4 lung tumors have been considered less suitable for surgery, because of their local extension invading central structures or vertebral bodies. To date, many studies have confirmed the advantages in terms of survival of a multimodality approach made up of surgical resection associated with neoadjuvant and/or adjuvant therapy for selected patients with advanced lung cancer. In those patients, in fact, minimally invasive surgery could improve overall survival rates while promoting faster recovery, faster access to adjuvant therapies and preserving a better functionality of the immune system. Because of the difficulty in collecting data on patients with T4 lung tumors amenable to minimally invasive surgery, published evidences only come from case reports which prove the feasibility and the possible advantages of video-assisted thoracic surgery (VATS) procedures. The aim of this literature review is to collect the published experiences of skilled surgeons dealing with T4 tumors invading central structures or chest wall, to analyze concerns and new opportunities of treatment and proving the feasibility and advantages of the VATS approach.

Fast-track rehabilitation following video-assisted pulmonary sublobar wedge resection: A prospective randomized study.

BACKGROUND:Postoperative morbidity and inhospital length of stay are considered major determinants of total health care expenditure associated with thoracic operations. The aim of this study was to prospectively evaluate the role of video-assisted thoracic surgery (VATS) compared to mini-muscle-sparing thoracotomy in facilitating early recovery and hospital discharge after pulmonary sublobar wedge resections.PATIENTS AND METHODS:A total number of 120 patients undergoing elective pulmonary sublobar wedge resection were randomly assigned to VATS (n = 60) or mini-muscle-sparing thoracotomy (n = 60). The primary endpoint was time to hospital discharge. Postoperative complications, cardiopulmonary morbidity and 30-day mortality served as secondary endpoints.RESULTS:Patients' baseline demographic and clinical data did not differ among study arms as well as the number of pulmonary segments resected and the morphology of the nodular lesions. Total hospital stay was significantly shorter in patients assigned to the thoracoscopic technique as opposed to those who were operated using the mini-muscle-sparing thoracotomy approach (4 ± 0.6 versus 4.4 ± 0.6 days respectively, P = 0.006). Multivariate analysis revealed that VATS approach was inversely associated with longer inhospital stay whereas the number of resected segments was positively associated with an increased duration of hospitalization. Patients in the VATS group were less likely to develop atelectasis (≥1 lobe) compared to those who underwent thoracotomy (0% versus 6.7% respectively, P = 0.042). Kaplan-Meier analysis revealed similar 30-day mortality rates in both study arms (Log-rank P = 0.560).CONCLUSION:VATS was associated with shorter duration of hospitalization positively affecting the patients' quality of life and satisfaction. Significant suppression of the total cost of recovery after thoracoscopic pulmonary resections is expected.

Moving beyond the boundary: the emerging role of video-assisted thoracic surgery for bronchoplastic resections.

Sleeve resections with parenchymal sparing should be attempted whenever possible when operating a central lung cancer rather than performing a pneumonectomy. Long-term results conclusively favored sleeve procedures in improved survival, quality of life, reduced loss in lung function, and improved operative mortality. Therefore, all surgeons should own this technique in their surgical armamentarium. In the last two decades, the minimally invasive surgical approach has slowly gained positions in Thoracic Surgery and now more and more patients ask for a minimally invasive procedure when surgery is required. This technical revolution in thoracic surgery advocates that almost every open procedure could be done in video-assisted thoracic surgery (VATS). Nevertheless, like all other minimally invasive procedures, VATS sleeve lobectomy has a long learning curve. With the skills and the experience derived from major VATS procedures, these demanding surgical operations may also be performed with a minimally invasive approach.

Invited Commentary

The exact role of video-assisted thoracic surgery (VATS) pneumonectomy in lung cancer management is still uncertain and requires both clinical and laboratory investigation. Nagai and colleagues [1] have reported on a retrospective review of their 12-year experience with VATS pneumonectomy. Forty-seven consecutive patients were carefully selected for this minimally invasive resection based on preoperative features and thoracoscopic determination of the feasibility of the procedure. Their low conversion rate (2.1%), mortality rate (2.2%), and major morbidity rate (15.2%) deserve commendation.

The role of VATS in the staging of non small cell lung cancer

Introduction:Since determining of prognosis and treatment method is related to accurate evaluation of TNM staging of non small cell lung cancer (NSCLC), we aimed to evaluate the role of Video-assisted thoracic surgery (VATS) in staging of NSCLC.Materials and Methods:This study was performed on 40 patients with NSCLC who had undergone preoperative staging and were candidate for curative surgery between 2008-2010. They underwent VATS immediately before the surgery. After performing VATS, the patients underwent thoracotomy by posterolateral incision unless any criteria of inoperability were present. Diagnostic accuracy of VATS for confirmation or modification of preoperative staging was evaluated.Results:M/F ratio was 21/19. Mean age of the patients was 57.2 ± 16.64 yrs. The most common symptom was coughing in 90% of patients. 72.5% of the patients had endobronchial mass and only for 27.5% tissue sample was obtained by transthoracic needle biopsy (TTNB) method. After performing VATS, 6 patients were excluded from surgery (3 cases (7.5%) due to seeding plural metastasis, 2 cases (5%) due to N2 involvement and one case (2.5%) due to satellite lesion in other lobes). Other 34 patients underwent surgery. Surgical resection was performed successfully in 31 cases (77.5%), but in 3 cases (7.5%) due to adhesion to hillum of the lung tumor was not resectable. According to the above results, VATS diagnosing accuracy was 92.5%.Conclusion:VATS can help to determine TNM staging and prevent unnecessary thoracotomy in some patients and we recommend this method for accurate staging of NSCLC.

The role of video-assisted thoracic surgery in the surgical treatment of superior sulcus tumors

The surgical resection of sulcus superior tumors, also referred to as Pancoast tumors, remains a challenging surgical procedure. A patient presented with a superior sulcus tumor situated anterior in the thoracic inlet. The tumor was resected through a transmanubrial approach of Grunenwald combined with a video-assisted thoracic surgery (VATS) lobectomy. VATS can be very helpful in determining the exact location of the resection and at the same time performing a lobectomy avoiding extra morbidity due to a classical thoracotomy.

Diagnosis, treatment and long-term outcome of solitary fibrous tumours of the pleura

Solitary fibrous tumours of the pleura (SFTP) are rare and can histologically be differentiated into benign and malignant forms. The aim of this study is to present new cases, and discuss up-to-date preoperative examinations, the role of video-assisted thoracic surgery and long-term outcome. Between 1993 and 2006, 27 SFTPs were diagnosed (14 females, mean age+/-SD, 62.3+/-9.6 years) at our institution. Medical records were reviewed, and follow-up was obtained by repeated examinations or contact with general practitioners. SFTPs were associated with symptoms in 63% of all cases. In the six patients in which positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) was performed preoperatively, malignant lesions were all found to be positive. Complete resection was achieved by video-assisted thoracic surgery in 15 and anterolateral thoracotomy in 12 patients. Mean hospital stay was shorter for patients operated by video-assisted thoracic surgery compared to thoracotomy, 4.5 (range 3-6) versus 7.5 (range 4-25) days, respectively (p<0.01). Histology revealed 17 benign and 10 malignant SFTP. Mean+/-SD tumour diameter of malignant SFTPs was larger than in benign forms, 11.9+/-7.1 versus 6.1+/-3.5 cm, respectively (p<0.01). Tumour recurrence was recognised in four patients with malignant SFTPs at a median time interval after surgery of 38 (range 6-122) months, two late deaths occurred resulting from tumour recurrences. SFTPs can be treated minimally invasively by video-assisted thoracic surgery with short hospital stay. Large SFTPs with increased FDG-uptake have a high likelihood for malignancy. Long-term follow-up is mandatory in malignant SFTPs because of late recurrences associated with death.

CLC068 POSTER Role of video-assisted thoracic surgery in staging and palliation of patients with lung cancer

CLC068 POSTER Role of video-assisted thoracic surgery in staging and palliation of patients with lung cancer

Role of video-assisted thoracic surgery in the evaluation and management of thoracic injuries

The aim of this study was to evaluate the experience of our institution with the use of video-assisted thoracic surgery (VATS) in chest trauma. Between January 1999 and September 2004, 25,213 patients presented with chest trauma to the emergency room, and 2304 were admitted to our service. Twenty-three hemodynamically stable patients (1%) underwent VATS. They were 19 men and 4 women with an average age of 42 years (range, 19-67 years). Indications included post-traumatic hemothorax in 11 patients, and post-traumatic empyema in 3, treated after 24 h of trauma. Indications for exploratory VATS in the acute phase included suspected diaphragmatic injury in 3 patients, persistent pneumothorax in 2, continued hemorrhage in 2 and removal of intrathoracic foreign body in 2. There was no mortality and complications occurred in 3 patients (13%). Management of hemodynamically stable thoracic injuries by using VATS provides diagnostic accuracy and therapeutic efficacy. It can be successfully applied in the trauma setting and surgeons should gain experience with its use.

The role of Video-assisted thoracic surgery (VATS) in general thoracic surgery to come in Japan

The role of Video-assisted thoracic surgery (VATS) in general thoracic surgery to come in Japan

Is video-assisted thoracic surgery justified at first spontaneous pneumothorax?

The fundamental role of video-assisted thoracic surgery (VATS) in the treatment of spontaneous pneumothorax is generally acknowledged today. This study intends to evaluate whether VATS is justified at the onset of a first spontaneous pneumothorax through analysis of parameters tested on two group of patients treated respectively with pleural drainage and VATS. The study includes 70 patients affected by first spontaneous pneumothorax divided into two groups of 35 patients for the purpose of therapeutic treatment. The first group underwent pleural drainage while the second underwent VATS. Parameters analyzed were as follows: (1) prolonged air leaks (more than 6 days); (2) time required for pleural drainage; (3) time of hospital stay; (4) management costs; (5) recurrences (follow-up at 12 months). Prolonged air leaks occurred in four patients (11.4%) in the first group and two patients (5.7%) in the second; recurrences occurred in eight patients in the first group (22.8%), and only one in the second group (2.8%). Mean time for drainage and hospitalization was, respectively, 9 and 12 days in patients with pleural drainage against 3.9 and 6 days of those using VATS. Average management costs per patients including hospitalization was calculated at $2,750.00 per patient for the first group compared with $1,925.00 for the second group. The use of VATS at first spontaneous pneumothorax is justified in the interest of both patients and health administrations as demonstrated by the number of recurrences in patients in the first group and economy savings resulting from use of VATS.

The Role of Video-Assisted Thoracic Surgery for Pulmonary Metastasectomy

Management of isolated metastatic deposits to the lungs and the role of surgical resection, specifically videoassisted thoracic surgery (VATS) techniques, have been controversial. The inability to perform a detailed bimanual palpation of the lung for occult lesions has been considered an inherent weakness in this approach. We have performed VATS resection for 205 patients with pulmonary metastatic disease and potentially curative VATS resection for 119 patients. VATS resection was successfully performed for all VATS diagnostic and therapeutic patients, with no perioperative deaths. Longitudinal follow-up demonstrated a mean survival of 20 months in the diagnostic group and 32 months in the therapeutic group. In the VATS therapeutic group, 44 (37%) patients remain free of disease at a mean follow-up of 37 months. Of the 69 recurrences, 6% were local, 25% were regional, and 67% were distant. In this review, the present role of VATS pulmonary metastasectomy will be examined.

Video-Assisted Thoracic Surgery-New Directions

Surgical techniques involving the endoscopic evaluation and treatment of diseases of the chest have progressed from their origins in the early 1900s to the modern era of video-assisted, minimally invasive thoracic surgery. As the surgical techniques and instrumentation evolve, the role of video-assisted surgery in a modern general thoracic surgical practice continues to be debated and to change accordingly. This review describes the current role of video-assisted thoracic surgery (VATS) in the management of diseases of the lung (bronchogenic carcinoma, emphysema, and interstitial disease), pleura (pleural effusions and empyema), and mediastinum (tumors and cysts, autonomic dysfunction, and pericardial disease).

Role of Video-Assisted Thoracic Surgery (VATS) in Staging, Diagnosis and Treatment of Lung Cancer

VATS, video-assisted thoracic surgery, is presently used for a variety of thoracic disorders and represents a new approach to thoracic disease. It plays a specific role in staging, diagnosis and treatment of lung cancer. For precise mediastinal lymph node staging, cervical mediastinoscopy remains the gold standard. VATS can replace anterior mediastinoscopy and is useful to take biopsies of lymph nodes not accessible by cervical mediastinoscopy and to judge resectability of the primary tumour. Precise diagnosis of solitary pulmonary nodules is possible by VATS but protective measures should be taken to prevent spillage of tumour cells. Positron emission tomography has recently proven to be valuable in staging and diagnosis of lung cancer but its precise role remains to be determined. VATS is presently not advocated for definite treatment of lung cancer. The only possible exceptions are peripheral T1N0 squamous cell carcinomas smaller than 2 cm., but resections less than lobectomy are oncologically not adequate.

Analysis of thoracoscopy in trauma.

The role of video-assisted thoracic surgery (VATS) in trauma has yet to be established. Up to the time of this writing, reviews of thoracoscopy in trauma have been primarily descriptive rather than analytic. This article analyzes the results of thoracoscopy (nonvideo and VATS) in trauma. Analysis was done by reviewing 28 nonoverlapping studies since the introduction of thoracoscopy in 1910, with a combined total of more than 500 patients. Diagnostically, thoracoscopy has been used primarily to evaluate diaphragmatic injury, continued chest tube bleeding, and suspected cardiac injury. Thoracoscopy has a 98% (188/191 patients) accuracy rate in diagnosing diaphragmatic injuries. Therapeutically, thoracoscopy has been used primarily to control chest tube bleeding, evacuate retained hemothoraces, and evacuate empyemas. Thoracoscopy is 90% (89/99 patients) effective in evacuating retained hemothoraces, 86% (19/22 patients) effective in evacuating empyemas, and 82% (33/40 patients) effective in controlling chest tube bleeding. Thoracoscopy benefits include preventing 62% (323/514) of trauma patients from having a thoracotomy or laparotomy. Risks include a 2% (11/534 patients) procedure-related complication rate and a 0.8% (4/471 patients) missed injury rate. Technical failure rates are 10% (10/99 patients) and 4% (7/199 patients) in evacuation of retained hemothoraces and evaluation of diaphragmatic injuries, respectively. Analysis suggests that thoracoscopy (nonvideo and VATS) can be applied safely and effectively in the care of the injured patient.

Video-Assisted Thoracic Surgery: Has Technology Found its Place?

Background. Since the introduction of minimally invasive surgical techniques in thoracic surgery in 1990, video-assisted thoracic surgery (VATS) has become the approach for many thoracic operations. The role of VATS has slowly evolved but has not been clearly defined. To better understand the role of VATS, we undertook a survey of practicing thoracic surgeons. Methods. A questionnaire was sent to members of the General Thoracic Surgery Club asking the role of VATS in their practice and their opinions regarding appropriate applications, advantages, and limitations of the approach. Results. Two hundred of the 229 members (87.3%) responded to the questionnaire. In this largely academic (66.3%) group of thoracic surgeons, 72% of whom had more than 10 years experience in general thoracic surgery, VATS was the preferred approach (>50% response) for the management of pleural disease, lung biopsy, recurrent pneumothorax, and sympathectomy. A majority of respondents thought that VATS was an acceptable approach for the diagnosis of the indeterminate pulmonary nodule and of anterior and posterior mediastinal masses, and for the management of early empyema, clotted hemothoraces, secondary pneumothorax, limited lung cancer treatment, and benign esophageal disease. Video-assisted thoracic surgery was thought to be unacceptable or investigational by a majority for thymectomy, lobectomy, and lung volume reduction operations. Video- assisted thoracic surgery still represents only a small portion of the thoracic procedures performed, but there is a gradual increase in its rate of use, although 38.1% expressed concern regarding overuse. The main limitation was thought to be in the management of oncologic disease. Conclusions. It appears that VATS is a valuable addition to the practice of thoracic surgery, but significant limitations exist. Although there appear to be many specific indications defined, there is still a significant evolutionary component.

Role of video-assisted thoracic surgery in the treatment of pulmonary metastases: Results of a prospective trial

A retrospective review revealed a 42% error rate between computed tomographic scan reports and thoracotomy findings; therefore, a prospective study was designed to compare the value of computed tomographic scans, video-assisted thoracoscopic exploration, and open thoracotomy in the management of pulmonary metastases. Eligibility included any patient with only one or two ipsilateral pulmonary metastases identified on computed tomographic scan who was being considered for surgical resection. Initially video-assisted thoracic surgery was performed and all lesions identified were resected. A thoracotomy adequate for complete lung palpation was then carried out and any additional lesions found were removed. Eighteen patients of a planned 50 were treated before closure of the study. Four patients (22%) had no additional lesions found at thoracotomy. The primary sites of tumor were colon (10), breast (3), and one patient each skin (squamous), cervix, kidney, melanoma, and sarcoma. Four patients (22%) did have additional lesions at thoracotomy, which were benign. In the remaining 10 patients (56%) additional malignant lesions were found at thoracotomy after video-assisted thoracoscopic exploration. After 18 patients were entered, analysis of the early results disclosed a 56% failure rate of a computed tomographic scan and video-assisted thoracic surgery to detect all lesions. Being within the 95% confidence interval (32% to 78%), the study was abandoned. We conclude that video-assisted thoracic surgery should be used only as a diagnostic tool in managing lung metastasis. A thoracotomy is required to achieve complete resection, which is the major survival prognosticator for satisfactory long-term results.

Video-assisted thoracic surgery: Primary therapy for spontaneous pneumothorax?

This study assessed the role of video-assisted thoracic surgery (VATS) in current therapy for spontaneous pneumothorax. We compared a retrospective series of 89 patients treated conventionally with a consecutive group of 30 patients undergoing VATS pleural abrasion. The 89 earlier patients were predominantly male (81%). Treatment groups included observation/aspiration (7 or 17%), tube thoracostomy (32 or 36%), multiple tubes (7 or 9%), and thoracotomy (43 or 48%). Of the 30 patients treated with VATS, 18 (66%) were male. Primary indications for operation were recurrent pneumothorax (17) and persistent air leak (9). Hospital lengths of stay (LOS) for the earlier group were 5 days for simple tube and 7 days for primary thoracotomy; LOS for initial intervention followed by thoractomy exceeded 15 days in all subgroups. The average LOS in the VATS group was 13 days; 6 patients treated with primary VATS (no chest tube) had a mean LOS of 6.5 days. Complications included 3 (10%) prolonged air leaks (more than 7 days) and 2 (7%) early recurrences. We do not recommend VATS as primary therapy for spontaneous pneumothorax; tube thoracostomy remains the treatment of choice. However, we strongly support surgical intervention early (3 days) in patients with a persistent air leak, and as primary therapy in a nonurgent situation if standard indications exist. This study shows no advantage of VATS over conventional thoracotomy in hospital stay or complication rate.