Preliminary Experience With Thoracoscopic Surgery

Abstract

ABSTRACT

Thoracoscopic surgery was accomplished in 12 patients utilizing thoracoscopic instruments and a stapler. Five patients were treated for recurrent, spontaneous pneumothoraces, for which blebectomies were done; three patients for pulmonary nodules, for which wedge resections were done; one patient for cryptogenic pleural effusion; one patient for debridement of an empyema cavity; one patient for traumatic bronchopleural fistula; and one patient with AIDS for interstitial lung disease. All patients were done under general anesthesia in the lateral decubitus position and were prepped and draped for a standard thoracotomy. They underwent endobronchial double-lumen ventilation so that the ipsilateral lung could be deflated to create a working space. In addition, insufflation of 4 to 5 mmHg was also used. Trocars were placed using a blunt technique. The mid-axillary trocar was at about the eighth intercostal space and was used for the endoscope, and then additional trocars were placed, usually on the anterior axillary line and posterior axillary line at about the fifth intercostal space. If adhesions were encountered, the lung was grasped atraumatically with a clamp or retractor used to give countertraction, and the adhesions were lysed with shears or electrocautery. After a thorough exploration of the hemithorax involved, the area of pathology was grasped with the clamp, which was used for countertraction. Through a 12 mm trocar, a stapler was introduced and fired. This staples and also transects on a 3 cm length. Several firings were usually necessary to remove the pathology, which, if malignant, was placed in a retrieval bag. When mechanical pleurodesis was felt necessary, this was accomplished using a sponge stick clamp, into which a 2 X 2 dry gauze was placed and used to abrade the parietal pleura. The patients then had a chest tube placed under direct vision through one of the trocars. The patients experienced only moderate pain in the immediate postoperative period, with essentially no pain by the fourth postoperative day. There were no significant complications noted and no deaths occurred.