DOI: http://dx.doi.org/10.18203/2349-2902.isj20210377

Safety and efficacy of video assisted thoracoscopic surgery for non-malignant pathologies: a prospective observational study

Raj N. Gajbhiye, Bhupesh Harish Tirpude, Akshay Dhahiya, Vikrant Akulwar, Hemant Bhanarkar, Gayatri Deshpande, Deepa Jhahagirdar, Girish Kodape

Abstract


Background: Video-assisted thoracic surgery (VATS) had been widely accepted because of its low complication rate, tolerable postoperative pain and early recovery of pulmonary function. Hence the present study was undertaken to assess safety and efficacy of VATS and also analyze the surgical outcomes of VATS procedures for non-malignant thoracic pathologies.

Methods: A total of 32 patients with non-malignant pathologies of thorax to undergo VATS lobectomy and thoracotomy conversion cases initially approached by VATS lobectomy were enrolled. Demographic data and surgical information were noted and compare between infection and non-infection group. Primary outcomes were thoracotomy conversion rate, period of thoracic drainage, length of hospital stay, and complications.

Results: The majority of patients were in the age group of 36-45 years (28.12%) with female predominance (62.50%). The commonest clinical presentation was hydropneumothorax (28.12%). Most common infective and non-infective aetiology was lung hydatid (28.12%) and benign nodule (18.75%) respectively. The commonest surgical procedures conducted using VATS were lobectomy (34.37%), and decortication (25%). The mean blood loss among the cases was 315.9±36.46 ml. Mean operative time was 157.18±12.37 minutes. Among 6.25% cases thoracotomy was conducted in view of difficult hilar dissection, while among 3.12% cases each of indistinct anatomy and bleeding. Mean duration of thoracic drainage was 6.78±1.69 days and mean hospital stay was 8.2±3.2 days. 6.25% cases had fatal complications while 21.87% cases had milder complications. Only one case recurred while 96.87% cases cured.

Conclusions: VATS lobectomy for benign disease is feasible and effective in selected cases, regardless of the presence of infection.


Keywords


Benign, Hydropneumothorax, Pathology, Lobectomy, Non-malignant, Thoracotomy, Video-assisted thoracic surgery

Full Text:

PDF

References


Roviaro GF, Varoli O, Nucca C, Vergani C, Maciocco M. Videothoracoscopic approach to primary mediastinal pathology. Chest. 2000;117:1179-83.

Elkhayat H, Kaya, SO, Ghoneim A, Khairy, M. Video Assisted Thoracoscopic Surgery (VATS) safety and feasibility in Benign Pathologies? J Tuberc Ther. 2016;1(1):103.

Ball M, Padalia D. Anatomy, Airway. in: StatPearls. Treasure Island (FL): StatPearls Publishing; 2019.

Stoica SC, Walker WS. Video assisted thoracoscopic surgery. Postgrad Med J 2000;76:547-50.

Paul S, Altorki NK, Sheng S, Lee PC, Harpole DH, Onaitis MW. Thoracoscopic lobectomy is associated withlower morbidity than open lobectomy: A propensity-matched analysis from the STS database. J ThoracCardiovasc Surg. 2010;139:366-78.

Ceppa DP, Kosinski AS, Berry MF, Tong BC, Harpole DH, Mitchell JD, D’Amico TA, Onaitis MW. Thoracoscopic lobectomy has increasing benefit in patients with poor pulmonary function: a Society of Thoracic Surgeons Database analysis. Ann Surg. 2012; 256:487-93.

Whitson BA, Andrade RS, Boettcher A, Bardales R, Kratzke RA, Dahlberg PS, Maddaus MA. Video-assisted thoracoscopic surgery is more favorable than thoracotomy for resection of clinical stage I non-small cell lung cancer. Ann Thorac Surg. 2007;83:1965-70.

Onaitis MW, Petersen RP, Balderson SS, Toloza E, Burfeind WR, Harpole DH Jr, D’Amico TA. Thoracoscopic lobectomy is a safe and versatile procedure: Experience with 500 consecutive patients. Ann Surg. 2006;244:420-5.

Li Z, Liu H, Li L. Video-assisted thoracoscopic surgery versus open lobectomy for stage I lung cancer: a meta-analysis of long-term outcomes. Exp Ther Med. 2012;3:886-92.

Taioli E, Lee DS, Lesser M, Flores R. Long-term survival in video-assisted thoracoscopic lobectomy vs open lobectomy in lung-cancer patients: A meta-analysis. Eur J Cardiothorac Surg. 2013;44:591-7.

Yim AP, Ko KM, Ma CC, Chau WS, Kyaw K. Thoracoscopic lobectomy for benign diseases. Chest. 1996;109:554-6.

Weber A, Stammberger U, Inci I, Schmid RA, Dutly A, Weder W. Thoracoscopic lobectomy for benign disease–a single centre study on 64 cases. Eur J Cardiothorac Surg. 2001;20:443-8.

Kim D, Kim HK, Choi YS, Kim J, Shim YM, Kim K. Is video-assisted thoracic surgery lobectomy in benign disease practical and effective? J Thorac Dis 2014;6:1225-9.

Kumar A, Asaf BB, Puri HV, Sharma MK, Lingaraju VC, Rajput VS. Video-assisted thoracoscopic surgery lobectomy: The first Indian report. J Min Access Surg. 2018;14:291-7.

Mazzella, A, Olland, A, Garelli, E. Video-assisted thoracoscopic surgery is a safe option for benign lung diseases requiring lobectomy. Surg Endosc. 2017;31:1250-6.