VATS Techniques Research Articles

Bibliometric analysis of 40 most cited articles comparing video-assisted thoracic surgery and robotic-assisted thoracic surgery in lung cancer (1997–2021)

BackgroundIn recent years, conventional thoracoscopic surgery has been accepted as the traditional treatment method in the non-small cell lung cancer (NSCLC). VATS and RATS, which are the techniques of this surgical method, have been increasing their effectiveness and applicability of late years. The aim of this bibliometric analysis is to evaluate the importance and efficiency of articles comparing VATS and RATS techniques. Materials and methodsStudies comparing VATS and RATS published between 1997 and 2021 were identified in the Web of Science database (accessed on 31. 12. 2021). The 40 most cited studies were analyzed in terms of publication years, country of study, authors, institutions that the authors were affiliated with, journal, journal address and impact factor. ResultsWhile an article was cited a maximum of 187 times when the citations made by the authors were excluded from the analysis, it was observed that all publications were cited a total of 1946 times. It was seen that an average of 51. 30 ± 47. 73 (8–187) articles were cited. In the 25-year, the highest number of publications was reached in 2019, while eight articles were published this year. The Annals of Thoracic Surgery (n = 13, 32. 5 %) was the journal in which the articles in the list were published the most. Most of the articles in our study (n = 31, 77.5 %) were published in US journals. While many studies presented more than one topic and analysis, the topic of most interest in 19 (47.5 %) studies was postoperative complications. ConclusionThis bibliometric analysis reflects important and qualified articles comparing VATS and RATS technique in thoracic surgery, but it can also be used to explain or explain the performance and results of these techniques, their positive and negative aspects, and their superiority over each other.

Nodal Upstaging Evaluation After Robotic-Assisted Lobectomy for Early-Stage Non-small Cell Lung Cancer Compared to Video-Assisted Thoracic Surgery and Thoracotomy: A Retrospective Single Center Analysis.

Introduction: The standard surgical procedures for patients with early-stage NSCLC is lobectomy-associated radical lymphadenectomy performed by using the thoracotomy approach. In the last few years, minimally invasive techniques have increasingly strengthened their role in lung cancer treatment, especially in the early stage of the disease. Although the lobectomy technique has been accepted, controversy still surrounds lymph node dissection. In our study, we analyze the rate of upstaging early non-small cell lung cancer patients who underwent radical surgical treatment using the robotic and the VATS techniques compared to the standard thoracotomy approach.Methods and Materials: We retrospectively reviewed patients who underwent a lobectomy and radical lymphadenectomy at our Institute between 2010 and 2019. We selected 505 patients who met the inclusion criteria of the study: 237 patients underwent robotic surgery, 158 patients had thoracotomy, and 110 patients were treated with VATS. We analyzed the demographic features between the groups as well as the nodal upstaging rate after pathological examination, the number of dissected lymph nodes and the ratio of dissected lymph nodes to metastatic lymph nodes of the three groups.Results: The patients of the three groups were homogenous with respect to age, sex, and histology. The postoperative major morbidity rate was significantly higher in the thoracotomy group, and hospital stay was significantly longer. The percentage of the mediastinal nodal upstaging rate and the number of dissected lymph nodes was significantly higher in the robotic group compared with the VATS group. The ratio of dissected lymph nodes to metastatic lymph nodes was significantly lower compared with the VATS group and the thoracotomy group.Discussion: The prognostic impact of the R(un) status is still highly debated. A surgical approach that allows better results in terms of resection has still not been defined. Our results show that robotic surgery is a safe and feasible approach especially regarding the accuracy of mediastinal lymphadenectomy. These findings can lead to defining a more precise pathological stage of the disease and, if necessary, to more accurate postoperative treatment.

Uniportal and three-portal video-assisted thoracic surgery pulmonary lobectomy for early-stage lung cancer (UNIT trial): study protocol of a single-center randomized trial

BackgroundVideo-assisted thoracoscopic surgery (VATS) lobectomy is currently the recommended approach for treating early-stage non-small cell lung cancer (NSCLC). Different VATS approaches have been proposed so far, and the actual advantages of one technique over the other are still under debate. The aim of our study is to compare postoperative pain and analgesic drug consumption in uniportal VATS and triportal VATS for pulmonary lobectomy in early-stage lung cancer patients.MethodsThis study is a single-center, prospective, two-arm, parallel-group, randomized controlled trial. It is designed to compare uniportal video-assisted thoracic surgery (u-VATS) and three-port video-assisted thoracic surgery (t-VATS) in terms of postoperative pain. The trial will enroll 120 patients with a 1:1 randomization. The primary outcome is the assessment of analgesic drug consumption. Secondary outcomes are postoperative pain measurement, evaluation of postoperative pulmonary function, and metabolic recovery after pulmonary lobectomy.DiscussionThe choice of which VATS approach to adopt for treating patients undergoing pulmonary resection mostly depends on the surgeon’s preferences; therefore, it is hard to prove whether one VATS technique is superior to the other. Moreover, postoperative analgesic protocols vary consistently among different centers. To date, only a few studies have evaluated the effects of the most popular VATS techniques. There is no evidence about the difference between multiport VATS and u-VATS in terms of postoperative pain. We hope that the results of our trial will provide valuable information on the outcomes of these different surgical approaches.Trial registrationClinicalTrials.gov NCT03240250. Registered on 07 August 2017; retrospectively registered.

Karsinoid Tümörlerde Parankim Koruyucu Cerrahi Tedavi Sonuçlarımız ve Cerrahi Yaklaşımdaki Değişiklikler

INTRODUCTION: Hilar/mediastinal lymph node sampling with lobectomy are the most common surgical methods used for the surgical treatment of carcinoid tumors. Bronchoplastic approaches together with lobectomy enable sparing of normal lung tissue and provide an alternative surgical approach to avoid pneumonectomy by enabling sleeve resection for centrally located tumors. The aim of this study was to present our parenchyma-sparing open surgical treatment experiences with the carcinoid tumor cases operated in our clinic in light of the new developments in the literature METHODS: The 11 tumor cases that had been diagnosed with carcinoid tumor and undergone surgical resection at our clinic between 2006 and 2012 were retrospectively revealed for tumor epidemiology, diagnostic methods, tumor localization, surgical treatment method, type and stage and postoperative complications. RESULTS: There were 7 males and 4 females with a mean age of 54.81±13.75 years (31-72 years). Cough was the most common presentation symptom with 8 cases (72.7%). A bronchoscopic biopsy was used for the definite diagnosis in 8 cases (72.7%). There were 11 (84.6%) typical and 2 (15.4%) atypical carcinoid tumors in the 11 cases. The most common surgical methods were lobectomy in 7 cases (53.8%) (3 sleeve, 1 bronchoplastic) and wedge resection in 4 cases. We found bilateral synchronous and 3 years later metachronous carcinoid tumor in a single case. The postoperative pathology diagnosis was T2N0M0 in 6 cases (54.5%) and T1N0M0 in 3 cases (27.2%). There was 1 atelectasis and 1 prolonged air leak in the postoperative stage. DISCUSSION AND CONCLUSION: Although we still use thoracotomy and lobectomy for the surgical treatment of carcinoid tumors in our clinic, we currently prefer minimal invasive surgery with the VATS and robotic surgery techniques that are gradually becoming more popular.

Trends and Outcomes in Minimally Invasive Surgery for Locally Advanced Non–Small-Cell Lung Cancer With N2 Disease

Few studies examine outcomes by surgical approach in non-small-cell lung cancer (NSCLC) with N2 disease. We examined time trends in surgical approach and outcomes among patients undergoing minimally invasive (MIS, robotic and video-assisted thoracoscopic surgery [VATS]) vs open lobectomy in this patient population. We performed a retrospective analysis of patients from the National Cancer Database diagnosed with clinical Stage IIIA-N2 NSCLC from 2010 to 2016. We examined the yearly proportion of MIS vs open resections. Multivariable regression was used to assess the association of surgical approach with length of stay, unplanned readmissions, 30-day and 90-day mortality. Multivariable Cox proportional hazards modeling was used to assess the association of surgical approach with 5-year overall mortality. We identified 5741 patients who underwent lobectomy for Stage IIIA-N2 NSCLC (459 robotic, 1403 VATS, 3879 open). From 2010 to 2016, the proportion of minimally invasive procedures increased from 20% to 45%. MIS patients, on average, stayed 1 day less in the hospital (95% confidence interval [CI] 0.7, 1.5) and had lower odds of 90-day (odds ratio [OR] 0.74; 95% CI 0.54, 0.99) and 5-year mortality (OR 0.82; 95% CI 0.75, 0.91), compared to open resections. There was no difference in odds of readmission by surgical approach (OR 0.97; 95% CI 0.71, 1.33). Among MIS procedures, robotic resections had lower odds of 90-day mortality (OR 0.42; 95% CI 0.18, 0.97) than VATS. Among patients undergoing lobectomy for locally advanced N2 NSCLC robotic and VATS techniques appear safe and effective compared to open surgery and may offer short- and long-term advantages.

Video-assisted thoracoscopic surgery as the gold standard for lung cancer surgery.

Surgical resection remains the only effective means of cure in the vast majority of patients with early-stage lung cancer. It can be performed via a traditional open approach (particularly thoracotomy) or a minimally invasive approach. VATS is 'keyhole' surgery in the chest, and was first used for lung cancer resection in the early 1990s. Since then, a large volume of evolving clinical evidence has confirmed that VATS lung cancer resection offered proven safety and feasibility, better patient-reported post-operative outcomes, less surgical trauma as quantified by objective outcome measures and equivalent or better survival than open surgery. This has firmly established VATS as the surgical approach of choice for early-stage lung cancer today. Although impressive new non-surgical lung cancer therapies have emerged in recent years, VATS is also being constantly rejuvenated by the development of 'next generation' VATS techniques, the refinement of VATS sublobar resection for selected patients, the utilization of bespoke post-operative recovery programmes for VATS and the synthesis of VATS into multi-modality lung cancer therapy. There is little doubt that VATS will remain as the gold standard for lung cancer surgery for the foreseeable future.

PL03.04 Lung Cancer and Tuberculosis: Parallel Lives

It is a Battlefield Searching for parallelisms, using historical analogies is a well established method in many fields of soft sciences, medical humanities included. A challenge of seemingly repetitive failure patterns and paradigm shift structures are to be answered in the following imaginary experiment. The aim is the creation of a mental model where understanding of developments and mistakes in treatment of tuberculosis might support our fight against lung cancer (1). The two diseases are existing parallely – one mainly for the poor and young and the other for the richer and older. History of tuberculosis follows the classic algorhythm: diagnostic (Villemin, Virchow), casuistic (Koch) and therapeutical (Waksman/Streptomycin) stages. The therapeutical phase of lung cancer has been reached without identified cause of the disease. Eradication of the macrosocopic focus by physical interference with the involved tissue mass, in both diseases preceeded medical treatment. Causation is not an absolute sine qua non of an effective treatment, as the tuberculosis-lung cancer analogy also proves. While lung cancer seems to be controlled by an emerging array of new drugs, tuberculosis poses a new challenge. Tuberculosis of the lung is a systemic disease, best treated by drugs with additional surgical removal of the focus of the disease as a last option. The disease has a fairly good chance of around 90% of to be cured (2). The prognostic factors include the functional and immunological reserves of the patient. Stage I to III lung cancer is a local manifestation of a systemic disease without sufficiently identified aetiology. Therapy response is understood at cohort level, but it is unpredictable where the individual patient’s fate is concerned. For reasons unknown, mechanical eradication offers the best chance for cure in early stages of the tumour. Some parallelism between tuberculosis and lung cancer might be of interest. In Search of a Character If progress takes a standstill categorization, fever takes over. Lymphnodes are the central elements of the Ghon and Ranke complexes. (3) of the tuberculous lung. The TNM system, a topology approach gyrates around the N status as well. (4). The desire to find a strong characteristic prognostic/predictive element resulted in the Gaffky index (5). The number of Koch bacillus in the sputum as a prognostic tool failed to validate the theory. The discussions of stations and size of lymphnodes in lung cancer (6) might share the fate of the Gaffky index. A Burnt out Case? There are disturbing similarities in the phenomenon of a late relapse/recurrence in both diseases. The dormant Koch bacillus vs exogenous reinfection debate (7) is paralleled by the dormant cancer cell hypothesis (8). Journey without Maps Circulating Koch bacillus, and their prognostic value hotly debated in the 1920s, are comparable to the circulating tumor cell question. The bloodstream journey polemic settled down by 1950, the “seed and soil” theory of cancer cells is subject of intense research. The Heart of the Matter Till the 1960s all tuberculosis cases seemed to be the same, until atypical tuberculosis was identified and the Mycobacterium xenopi lost its stigmatising power (95). Certain phenotypes of the adenocarcinoma in situ behaves definitely in a more benign way than any other cell type NSCLC. In 2019, we still do not know what is the single causative agent (if it exists at all) of NSCLC (if it exists at all as a single entity). The Copernican revolution in tumour biology is still awaited. The Power and the Glory Tuberculosis taught us, that the disease affects the body and the soul as well, reflecting to the society around the patient as well. Lung cancer treatment also depend on the immune status of the individual as well as on the protective capabilities of the science and the society. Affordability and availability of anticancer treatments/drugs are key words yet not interchangeable (8). Onco-economy is as a powerful factor as gene sequencing. A scalpel for sale Our techniques to treat lung cancer are rooted in surgery for tuberculosis (1). VATS techniques take their origin in Jacobeus’ thoracoscopy and Veress needle. Modern thoracic surgical staplers are derivates of the “Russian machines”, Petz staplers adjusted to tuberculotic bronchi. Thoracic surgery practiced in local anesthesia for many decades, is genuine awake/non-intubated thoracic surgery of today. The recent debate over neoadjuvant vs. adjuvant therapy reflects to the bygone dispute on resection before or after antituberculous medical treatment. The different modalities are no mutually exclusive options, but complementary ones. The End of the Affair: The main message of tuberculosis to present day oncopulmonologists is that no one can forget the interaction between tumour and patient and his/her socioeconomic status around the pathologically identified focus.

A National Analysis of Long-term Survival Following Thoracoscopic Versus Open Lobectomy for Stage I Non-small-cell Lung Cancer.

The objective of this study was to compare the long-term survival of open versus thoracoscopic (VATS) lobectomy for early stage non-small-cell lung cancer (NSCLC). Data from national studies on long-term survival for VATS versus open lobectomy are limited. Outcomes of patients who underwent open versus VATS lobectomy for clinical T1-2, N0, M0 NSCLC in the National Cancer Data Base were evaluated using propensity score matching. The median follow-up of 7114 lobectomies (5566 open and 1548 VATS) was 52.0 months. The VATS approach was associated with a better 5-year survival when compared to the open approach (66.0% vs. 62.5%, P = 0.026). Propensity score matching resulted in 1464 open and 1464 VATS patients who were well matched by 14 common prognostic covariates including tumor size and comorbidities. After propensity score matching, the VATS approach was associated with a shorter median length of stay (5 vs. 6 days, P < 0.001). The VATS approach was not significantly different compared with the open approach with regard to nodal upstaging (11.6% vs 12.3%, P = 0.53), 30-day mortality (1.7% vs 2.3%, P = 0.50) and 5-year survival (66.3% vs 65.8%, P = 0.92). In this national analysis, VATS lobectomy was used in the minority of patients with stage I NSCLC. VATS lobectomy was associated with shorter length of stay and noninferior long-term survival when compared with open lobectomy. These results support previous findings from smaller single- and multi-institutional studies that suggest that VATS does not compromise oncologic outcomes when used for early-stage lung cancer and suggest the need for broader implementation of VATS techniques.

The cost and quality of life outcomes in developing a robotic lobectomy program.

The use of the robotic platform is increasingly being utilized for lung resections. Our aim was to compare outcomes of thoracoscopic (VATS) versus robotic-assisted thoracoscopic (RATS) lobectomy early in a program's adoption of robotic surgery, including perioperative outcomes, cost, and long-term quality of life. A prospective database was retrospectively reviewed for all patients undergoing minimally invasive lobectomy by either VATS or RATS techniques from 2010 to 2012. Patients' operative, post-operative complications, cost (operating room and hospital) and quality of life were compared between the two resection techniques. Long-term follow-up including assessment using the European Organization for Research and Treatment of Cancer quality of life questionnaire was documented. During the first 25 RATS lobectomies, there were 73 VATS lobectomies performed, for a total of 98 cases. There was no significant difference in cancer stage, operative time, estimated blood loss, lymph node count, or hospital length of stay. The RATS resections had significantly higher operative and total hospital cost (p < 0.0001 and p < 0.05). At a median of 65-month follow-up, 29 patients (9 robotic; 20 VATS) completed the EORTC questionnaire. The global health status and symptom scale median scores were similar to the general population and did not significantly differ between groups. While transitioning from thoracoscopic to robotic lobectomy incurs increased operative and total hospital cost, equivalent operative outcomes, length of hospitalization, and long-term quality of life can be maintained during this transition. With increasing patient and surgeon interest in robotic resection, it appears both safe and feasible to adopt this approach while maintaining outcomes.

No Adverse Outcomes of Video-Assisted Thoracoscopic Surgery Resection of cT2 Non-Small Cell Lung Cancer during the Learning Curve Period.

BackgroundVideo-assisted thoracoscopic surgery (VATS) anatomic lung resections are gradually becoming the standard surgical approach in early-stage non-small cell lung cancer (NSCLC). The technique is being applied in cases of larger tumors depending on the experience of the surgical team. The objective of this study was to compare early surgical and survival outcomes in patients undergoing anatomic pulmonary resections using VATS and thoracotomy techniques for clinical T2 NSCLC during the adaptation period of the surgical team to the VATS approach.MethodsThe data of all patients who underwent anatomic pulmonary resection for NSCLC using VATS and open techniques since April 2012 were recorded to create a prospective lung cancer database. Clinical T2 NSCLC patients who underwent VATS anatomic lung resection were identified and compared with cT2 patients who underwent open resection.ResultsBetween April 2012 and August 2014, 269 anatomical resections for NSCLC were performed (80 VATS and 189 thoracotomy). Thirty-four VATS patients who had clinical T2 disease were identified and stage-matched to thoracotomy patients. The average tumor diameter was comparable (34.2±11.1×29.8±10.1 mm vs. 32.3±9.8×32.5±12.2 mm, p=0.4). Major complications were higher in the thoracotomy group (n=0 vs. n=5, p=0.053). There was no 30-day mortality, and the 2-year survival rate was 91% for VATS and 82% for thoracotomy patients (p=0.4).ConclusionVATS anatomic resections in clinical T2 NSCLC tumors are safe and have perioperative and pathologic outcomes similar to those of thoracotomy, while remaining within the learning curve.

Image-guided navigation and video-assisted thoracoscopic spine surgery: the second generation

Video-assisted thoracoscopic surgery (VATS) has evolved for treatment of a variety of spinal disorders. Early incorporation with image-guided surgery (IGS) was challenged due to reproducibility and adaptability, limiting the procedure's acceptance. In the present study, the authors report their experience with second-generation IGS and VATS technologies for anterior thoracic minimally invasive spinal (MIS) procedures. The surgical procedure is described in detail including operating room set-up, patient positioning (a lateral decubitus position), placement of the spinal reference frame and portal, radiographic localization, registration, surgical instruments, and the image-guided thoracoscopic discectomy. Combined IGS and VATS procedures were successfully performed and assisted in anatomical localization in 14 patients. The mean patient age was 59 years (range 32-73 years). Disc herniation pathology represented the most common indication for surgery (n = 8 patients); intrathoracic spinal tumors were present in 4 patients and the remaining patients had infection and ossification of the posterior longitudinal ligament. All patients required chest tube drainage postoperatively, and all but 1 patient had drainage discontinued the following day. The only complication was a seroma that was presumed to be due to steroid therapy for postoperative weakness. At the final follow-up, 11 of the patients were improved neurologically, 2 patients had baseline neurological status, and the 1 patient with postoperative weakness was able to ambulate, albeit with an assistive device. The evolution of thoracoscopic surgical procedures occurring over 20 years is presented, including their limitations. The combination of VATS and IGS technologies is discussed including their safety and the importance of 3D imaging. In cases of large open thoracotomy procedures, surgeries require difficult, extensive, and invasive access through the chest cavity; using a MIS procedure can potentially eliminate many of the complications and morbidities associated with large open procedures. The authors report their experience with thoracic spinal surgeries that involved MIS procedures and the new technologies. The most significant advance in IGS procedures has resulted from intraoperative CT scanning and automatic registration with the IGS workstation. Image guidance can be used in conjunction with VATS techniques for thoracic discectomy, spinal tumors, infection, and ossification of the posterior longitudinal ligament. The authors' initial experience has revealed this technique to be useful and potentially applicable to other MIS procedures.

Thoracoscopic minimally invasive surgery for non-small cell lung cancer in patients with chronic obstructive pulmonary disease.

To determine the incidence of peri-operative complications in non-small cell lung cancer (NSCLC) patients with co-existent chronic obstructive pulmonary disease (COPD) who undergo lung resection via traditional and minimally invasive techniques. A retrospective analysis was conducted of 152 NSCLC patients with COPD who underwent thoracoscopic minimally invasive surgery. Particular attention is given to the relationship between disease severity or surgical approach and the incidence of complications. THE PREVALENCE OF RESPIRATORY AND CARDIAC COMPLICATIONS WAS SIGNIFICANTLY HIGHER IN PATIENTS WITH SEVERE/EXTREMELY SEVERE COPD THAN THOSE WITH MILD TO MODERATE COPD (RESPIRATORY COMPICATIONS: 37.3% vs. 20.4%, P=0.022; cardiac complications: 16.9% vs. 6.5%, P=0.040). Patients who underwent complete-video assisted thoracoscopic surgery (c-VATS) had a significantly lower overall morbidity of adverse reactions than those who had undergone VATS major resection (26.3% vs. 42.1%, P=0.044). Among patients with severe/extremely severe COPD, there was no significant difference in the incidence of any complication between the lobectomy group and wedge resection group (38.8% vs. 70.0%, P=0.072). Overall, the occurrence of adverse reactions was significantly lower in patients who underwent c-VATS than in those who had undergone VATS major resection surgery (34.2% vs. 61.9%, P=0.038). VATS techniques are suitable for COPD patients and are demonstrated here to lower the incidence of post-operative complications when compared with more invasive approaches.

Lessons learned from 110 consecutive vats lobectomies for primary, early-stage non-small cell lung cancer

7526 Background: When surgeons adopt and integrate VATS techniques into their practices, they often mimic open surgery via smaller incisions with the goal of performing the same operation. However,...

Is Minimal Access Surgery for Cancer Associated with Immunologic Benefits?

Minimal-access surgical techniques have been shown to be beneficial to patients in terms of shorter convalescence, reduced pain, and improved cosmesis. Although systemic immune function is better preserved following laparoscopic procedures when compared with their respective open approaches, CO2 pneumoperitoneum may significantly affect local (i.e., infra-abdominal) cellular immunity by reducing regional macrophage function. Results to date are conflicting with regard to the impact of closed and open methods on intraabdominal immunity. Impaired cellular immunity after CO2 pneumoperitoneum may have significant undesirable intra-abdominal effects on tumor surveillance after oncological surgery; however, at present, there is no clinical evidence to support this position. The VATS techniques avoid the use of CO2 insufflation, which may offer some advantages from the immune function perspective over laparoscopic procedures accomplished with CO2 pneumoperitoneum. Better preservation of early postoperative cellular immune function and attenuated disturbance in the inflammatory mediators are likely contributing factors to the clinical benefits that follow laparoscopic surgery and VATS. Larger multi-center randomized trials are needed to confirm the potential benefits of minimal-access surgery on patient survival after cancer surgery. Future research should focus on the effects of minimal-access surgery on other mediators (such as MMP-9, IGFBP-3, IL-12, IL-17, and IL-23) that may be important in tumor cell dissemination, deposition, and propagation in the early postoperative period. Furthermore, additional searches for other factors or mediators, heretofore unrecognized, should be carried out. Such studies will, we hope, increase our knowledge and understanding of the impact of surgery on immune and other physiologic functions.

VATS Lung Biopsy in Suspected, Diffuse Interstitial Lung Disease Provides Diagnosis, and Alters Management Strategies

Objectives. In patients with suspected diffuse interstitial lung disease, open lung biopsy is associated with high mortality (16%). This risk is only acceptable if diagnosis is made and management enhanced. We reviewed the role of VATS techniques in this group to determine the morbidity, mortality and outcomes in terms of diagnosis and enhanced management. Methods. Over the period of 5 years, 78 patients with suspected diagnosis of diffuse interstitial lung disease on clinical and radiological grounds were referred to a single surgical team. The patients’ case notes and histology reports were reviewed retrospectively. Correlation was made with histopathological diagnosis. Results. All 78 patients had sufficient provision of material for histological analysis. Eight patients had a histological diagnosis not consistent with diffuse interstitial lung disease; in all eight patients, this significantly altered the subsequent management. Of the 70 patients with diffuse lung disease, 26 patients (37.1%) had a histological diagnosis of usual interstitial pneumonia. Thirteen patients (18.6%) had a histological diagnosis of unclassifiable diffuse lung disease despite an adequate biopsy. The remaining 31 patients (44.3%) had other positive histological diagnosis made. A difference between pre-operative clinico-radiological and final histological diagnosis sufficient to change prognosis and definitive management was made in 19 patients (27.1%). The mean and median post-operative stay was 2.8 days and 2 days, respectively. The in-hospital mortality was one patient (1.5%) due to adult respiratory distress syndrome. Conclusions. VATS lung biopsy can be performed in this group of patient with low mortality of 1.5%. It provides sufficient material for histological diagnosis in 100% of patients and alters the management and prognosis in a significant number of patients. We propose that the role of VATS and clinico-radiological techniques should be compared in a prospective controlled clinical trial.

VIDEO-ASSISTED THORACIC SURGERY FOR DISEASES WITHIN THE MEDIASTINUM

VATS and concepts of minimal access thoracic surgery have revitalized many aspects of general thoracic surgery, including the surgical approach to diseases and conditions of the mediastinum. Proven surgical options that have been shunned by patients and referring physicians because of the perceived morbidity of thoracotomy have been reconsidered with the emergence of these minimal access surgical options. Continued critical review of the accumulating experience in VATS techniques will refine the surgical indications for VATS and open thoracotomy.