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EndoScoops
Back around the turn of the century, a few adventurous surgeons used cystoscopes to endoscopically examine the pleural cavity for diagnostic purposes.
Today, video-assisted thoracic surgery, or VATS as it is known, has come a long way, with appropriately trained thoracic surgeons using minimally invasive techniques to perform such complicated procedures as lobectomies and lung volume reduction surgery for patients with severe emphysema.
But certain thoracic surgeries, particularly those intended for diagnostic exploration, can be done by properly trained general surgeons who are skilled at laparoscopy. As noted by Mukaram Gazi, MD, of the Robert Wood Johnson Medical Center, New Brunswick, NJ, a joint commission on VATS formed in 1992 by the American Association of Thoracic Surgery and the Society of Thoracic Surgeons determined that general surgeons can perform simple thoracic procedures.
"In Europe," added associate P.D. Jadeja, MD, "pulmonologists perform VATS themselves, for both diagnostic and therapeutic purposes." Indications for VATS include several diagnostic procedures. "For example," Dr. Gazi said, "diagnosing pleural effusions when looking into the pleural cavity is required, or when pulmonary nodules cannot be diagnosed through radiological means. Also, diagnostic VATS is used to stage tumors and to visualize pulmonary infections in people with HIV." Contraindications are generally obvious and include those with coagulation problems and those with an invasive tumor in the hilar portion of the lung.
VATS is now being embraced by a growing number of surgeons for a growing number of therapeutic procedures. "General surgeons, for instance, can diagnose and treat patients with recurrent spontaneous pneumothoraces and perform wedge resections," Dr. Gazi continued. "The surgical approach generally involves establishing a port site for the scope through a midaxillary incision in the 5th intercostal space and then adding ports to facilitate viewing mainly in the anterior and posterior axillary areas." An endoscopic stapler like the MULTIFIRE ENDO GIA* stapler, which allows multiple firings and so can resect large portions of lung rapidly, is used. "This is generally followed by talc poudrage, which is a chemical pleurodesis technique. Talc is puffed into the area endoscopically." By avoiding thoracotomy and its extensive period of rehabilitation, VATS has decreased hospital stays, reduced pain and pain medications, and returned patients to work faster than even those peering through a cystoscope at the turn of the century would have ever imagined.
*Trademark of United States Surgical Corporation
Fall 1995 Vol 3 No 2Medical Editors:
Dr. William Kelley, Jr.
Dr. Douglas Olsen
Dr. Joseph Petelin
Editorial Director, Special Projects:
James Prudden
Principal Writer:
Laura A. McKeown
Creative Director:
Michele Velle, MAX Graphics
Art Director:
Frank Tagarello, MAX Graphics
Creative Systems Manager:
James O'Neill
Designer:
Oksana Olkovetsky
Copy Editor:
Christopher Davis
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Copyright © 1995 by Laparoscopy in Focus. Sponsored by an educational grant from United States Surgical Corporation.
The opinions expressed herein are those of the writers and interviewees and are not necessarily those of the publisher or sponsor.
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