Original ArticlesThoracoscopic Operations on Reoperated Chests☆
Section snippets
Patients
From September 1992 to December 1996, a total of 2,477 patients underwent VATS of whom 40 patients (33 men; age range, 9 to 78 years) had prior operations on the ipsilateral chests: 23 after prior open procedures (22 thoracotomies, 1 median sternotomy) and 17 after prior VATS. The average time interval between the two operations was 14.3 ± 8.3 months. Tube thoracostomy alone was not considered a prior operation for this study.
Operative Technique
With general anesthesia and selective one-lung ventilation, patients
Results
Adhesions were noted in all patients, ranging from minimal through fibrinous adhesions to strong, dense fibrous adhesions. However, in only two patients was the VATS procedure abandoned for open surgery. The first patient had a median sternotomy and bilateral resection of osteosarcoma metastases, and he was found to have a small peripheral solitary mass 6 months later. Attempts was made to explore the chest with VATS; however, because of adhesions and difficulty in locating the nodule, the
Comment
A previous chest surgical procedure is generally taken as a relative contraindication to VATS, even though this subject has been inadequately examined. Although some adhesions existed in all the patients in our study, there were only two procedures out of 40 (5%) that we could not complete using VATS. There was a general impression that the adhesions were more dense after thoracotomy compared with VATS, and both operations that required conversion had prior open procedures (one thoracotomy and
Acknowledgements
Supported by Earmarked Research Grant 1996 (CUHK 280/96M)
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