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Thoracoscopy

Stephen R. Hazelrigg, MD, Traves D. Crabtree, MD, Michael J. Thomas, MD
Thoracoscopy is a topic covered in the Pearson's General Thoracic.

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Key Points

  • Video-assisted thoracic surgery (VATS) is useful for undiagnosed exudative pleural effusions to rule out malignancy.
  • VATS is very effective for empyema before the chronic fibrous phase, which occurs after 3-4 weeks.
  • VATS wedge resection for peripheral nodules provides definitive diagnosis.
  • VATS lobectomy appears safe and comparable to open lobectomy when done by experienced thoracic surgeons.
  • Lung volume reduction study may be done by VATS or sternotomy with comparative long-term outcome results in regard to lung function, 6-minute walk, and oxygen requirements.
  • VATS sympathectomy approaches 100% success for palmar hyperhidrosis.
  • VATS pericardectomy may provide advantages over a subxiphoid approach when the cause is benign; for malignant sources, the subxiphoid route is typically preferred.

Thoracoscopy before 1990 was largely a diagnostic procedure that was mostly reserved for the evaluation of pleural disease. The emergence of better scopes and instruments has allowed thoracoscopy to evolve into a therapeutic modality. As evidence of its renewed popularity, a literature search of the word thoracoscopy yields 200 articles before 1990 and thousands of articles since. Thoracoscopic procedures using modified small incisions with scopes are referred to as video-assisted thoracic surgery, or VATS. This term, is probably more appropriate now than thoracoscopy, which simply suggests the use of a scope to look inside the thoracic cavity. In this chapter, indications, techniques, and complications of VATS for both diagnostic and therapeutic procedures are reviewed. For some procedures, VATS has replaced open approaches due to reduced morbidity, shortened hospital stay, better cosmetics, or better exposure,[1],[2],[3],[4],[5],[6],[7],[8],[9],[10] whereas in other procedures the advantages are not as clear.

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Key Points

  • Video-assisted thoracic surgery (VATS) is useful for undiagnosed exudative pleural effusions to rule out malignancy.
  • VATS is very effective for empyema before the chronic fibrous phase, which occurs after 3-4 weeks.
  • VATS wedge resection for peripheral nodules provides definitive diagnosis.
  • VATS lobectomy appears safe and comparable to open lobectomy when done by experienced thoracic surgeons.
  • Lung volume reduction study may be done by VATS or sternotomy with comparative long-term outcome results in regard to lung function, 6-minute walk, and oxygen requirements.
  • VATS sympathectomy approaches 100% success for palmar hyperhidrosis.
  • VATS pericardectomy may provide advantages over a subxiphoid approach when the cause is benign; for malignant sources, the subxiphoid route is typically preferred.

Thoracoscopy before 1990 was largely a diagnostic procedure that was mostly reserved for the evaluation of pleural disease. The emergence of better scopes and instruments has allowed thoracoscopy to evolve into a therapeutic modality. As evidence of its renewed popularity, a literature search of the word thoracoscopy yields 200 articles before 1990 and thousands of articles since. Thoracoscopic procedures using modified small incisions with scopes are referred to as video-assisted thoracic surgery, or VATS. This term, is probably more appropriate now than thoracoscopy, which simply suggests the use of a scope to look inside the thoracic cavity. In this chapter, indications, techniques, and complications of VATS for both diagnostic and therapeutic procedures are reviewed. For some procedures, VATS has replaced open approaches due to reduced morbidity, shortened hospital stay, better cosmetics, or better exposure,[1],[2],[3],[4],[5],[6],[7],[8],[9],[10] whereas in other procedures the advantages are not as clear.

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Last updated: April 29, 2020