Risk and hazards of video-thoracoscopic surgery: a collective review

OBJECTIVE: Since 1990, video-thoracoscopy has rapidly gained widespreadacceptance. In contrast to conventional thoracoscopy no comprehensivestudies of potential risks and hazards have been carried out. To dateinterest has centered on possible indications and thoracoscopic techniques.Based on a review of the literature, this article summarizes and commentson possible complications. METHODS: In a meta- analysis (Medline, January1989 until December 1994), all publications dealing with thoracoscopy werecollected. Those papers concerned with video-thoracoscopy were furtherevaluated if the following criterias were fulfilled: first, the endoscopistemployed a video-camera connected to the thoracoscope; second, separateentry sites were used for telescope and instruments. RESULTS: Of 345papers, 145 met the above criterias, 5280 thoracoscopies could be analysedfor more than 30 indications. The calculated mortality rate was 0.3% andthe complication rate 3.61%. In 55 of all cases (1.04%), the interventionhad to be converted to open surgery. CONCLUSIONS: Video-thoracoscopicthoracic surgery has gained acceptances as a complement to open thoracicsurgery. It may now be regarded as a safe technique. Nevertheless, seriouscomplications such as implantation metastasis of the thoracic wall afterthoracoscopy or injury to the recurrent nerve demonstrate the complexity ofthoracoscopic surgery. Practitioners should therefore be proficient inthoracic surgery. The importance of meticulous technique and rigidadherance to safety guidelines even in diagnostic procedures, must bestressed.