The present status of endoscopic thoracic surgery

Video-assisted thoracic surgery (VATS) is a major revolution in thoracic surgery. The procedure is performed under general anesthesia with double lumen endotracheal intubation for separate control of each lung. Operative ports should be placed carefully, avoiding damage to the intercostal vessels and nerves. The video technique can be used efficiently for the following indications: pneumothorax, resection of pulmonary nodules, biopsies of lung, pleura and mediastinal structures, resection of mediastinal tumors, management of empyema, and hemostasis and suture of lacerations after trauma. Indications for esophageal procedures include esophagomyotomy, fundoplication, and resection of benign lesions. Repair of esophageal perforation can be done at an early stage. Major resections of pulmonary and esophageal cancer are a matter of controversy. The apparent advantage of diminished pain is offset by spread of malignant cells and potential damage to the resected specimen with loss of important information concerning pathology. Complications of VATS are few and include prolonged air leak, dysrhythmia, respiratory failure and bleeding. VATS has become an inseparable part of thoracic surgery and should be included in the basic training of every thoracic surgeon.