Title: Complications of video-assisted thoracic surgery: A five-year experience
Abstract: Background.Although thoracoscopy was originally described in 1910, recent developments in video-assisted surgical techniques and endoscopic equipment has expanded the application of video-assisted surgical procedures in the field of thoracic surgery.Methods.In an effort to define both high-risk patients for video-assisted thoracic procedures and high-risk vid- eo-assisted thoracic surgical procedures, we reviewed the experience of four surgical institutions from June 1991 through May 1995.We looked specifically at complications resulting from the 937 video-assisted thoracic procedures performed during this period.Results.Perioperative incidents or complications occurred in 35 patients (3.7%), and 116 procedures (12.4%) were converted to a thoracotomy.The in-hospital mortality rate was 0.5%, and death occurred principally in patients operated on for malignant pleural effusion.The overall incidence of postoperative complications was 10.9%, and the most prevalent complications were prolonged air leak (6.7%) and pleural effusion (0.7%).Conclusions.The incidence of complications was acceptable and, except for that of prolonged air leak, did not differ significantly from that resulting from analogous open procedures.Video-assisted thoracic surgery appears safe and particularly useful for some indications.However, the possibility of dramatic life-threatening perioperative complications requiring emergency conversion to thoracotomy justifies the fact that only trained thoracic surgeons should perform video-assisted thoracic surgical procedures.