[Video-assisted surgery in the management of thoracic problems].

OBJECTIVE: To review the experience in minimally invasive videoassisted surgery for the diagnosis and treatment of thoracopulmonary problems. METHOD: Retrospective review of the clinical charts of patients submitted to thoracic videoassisted surgical procedures at the Instituto Nacional de Nutricion Salvador Zubiran from February 1993 to March 1995. RESULTS: A total of 102 patients were submitted to videoassisted thoracic surgery. There were three main indications for the procedure: 1) pleural disease (n = 30); 2) pulmonary disease (n = 66); and 3) various (n = 6). A total of 129 procedures were performed: 38 pleural procedures (biopsy 15, decortication 8, talc poudrage 7, revision/lavage 6, section of adhesions 1, and pleural abrasion 1), 75 pulmonary procedures (lung biopsy 32, pulmonary nodule wedge resection 30, large core needle biopsy 8, bullae resection 3, videoassisted lobectomy with minithoracotomy 2), and 16 various procedures (biopsy of mediastinal adenopathy 6, pericardial window 4, pericardial biopsy 4, subphrenic abscess 1, intercostal artery clippage 1). Morbidity appeared in three patients (two prolonged air leaks and one empiema) and two patients died (one cirrhotic patient who developed postoperative acute hepatic failure and a patient with lupus erythematosus who developed sepsis). All other patients had an uneventfull postoperative course with a mean pleural drainage of 1.76 days for pulmonary procedures (range 0.5-3 days) and 4.6 days for pleural procedures (range 2-15 days). CONCLUSIONS: The use of the videothorascope as an adjuvant in thoracic surgery allows the surgeon to perform different procedures using minimally invasive techniques. Indications are the same as for any thoracic surgical procedure and the general philosophy must be to establish a compromise between minimal invasion of the patient and the correct solution for the particular problem being treated.