Original Articles
Thoracoscopic Operations on Reoperated Chests

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Abstract

Background. A previous operation is generally considered to be a relative contraindication to the minimal access approach. We reviewed our combined experience from three centers with video-assisted thoracic surgery on reoperated chests.

Methods. From September 1992 to December 1996, 2,477 patients underwent video-assisted thoracic surgery of whom 40 patients (33 men; age range, 9 to 78 years) had prior operations on the ipsilateral side of the chest: 23 after prior open procedures (22 thoracotomies, 1 median sternotomy) and 17 after video-assisted thoracic surgery. The second procedures consisted of bullectomy or bulla ligation (8), mediastinal and hilar mass biopsy (8), wedge lung resection (6), pericardial window (5), lung volume reduction (4), redo thoracodorsal sympathectomy (3), talc insufflation alone (3), decortication (2), and suturing of a pleural rent (1).

Results. Adhesions were noted in all patients ranging from minimal to strong fibrous adhesions. However, in only 2 patients (5%) were the procedures abandoned because of adhesions. Video-assisted thoracic surgery was safely completed in all other patients. There was no mortality or intraoperative complications and mean hospital stay was 5.1 ± 3.2 days (range, 0 to 17 days).

Conclusions. Video-assisted thoracic surgery on reoperated chests is feasible and does not carry a higher morbidity or mortality compared with first-time operations, even though it may be technically more difficult. Experience and clinical judgment, however, are required to select these patients for reoperation with video-assisted thoracic surgery.

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)

References (5)

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