SINGLE-PORT VIDEO ASSISTED THORACOSCOPY: EXPERIENCE IN A COMMUNITY TEACHING HOSPITAL
Matthew Campbell MD, Steven Reitz MD, Aaron Kulwicki MD, Dennis Tishko MD, David S. McCready MS. Mount Carmel Medical Center, Columbus, Ohio
Single-port video-assisted thoracoscopic surgery (sVATS) is an alternative to conventional three-port thoracoscopy. Published reports in the literature have primarily consisted of small series from university hospitals, often describing the institution’s initial experience with the technique. Larger published series are usually limited to a narrow range of indications for the procedure. We report a series of sVATS procedures for a variety of indications performed by a single surgeon in a community teaching hospital.
We gathered data retrospectively on 119 consecutive patients who underwent sVATS between March 2004 and February 2005. Data include indication, inpatient vs. outpatient status, age, sex, tobacco use, length of stay, duration of tube thoracostomy, resident participation, use of epidural anesthesia, operative time, conversion to thoracotomy, and mortality.
Indications for sVATS included pulmonary nodule (78), persistent infiltrate (14), effusion (11), pneumothorax (9), and empyema (7). Overall median length of stay was 2 days (range, 0-16). Mean operative time was 58 minutes (range, 18-170). During the procedure, 17 patients required conversion to thoracotomy. There was no difference in the rate of conversion to thoracotomy when comparing inpatient and outpatient procedures. Four patients died postoperatively (3%), the majority of which were diagnosed with advanced malignancy and requested palliation. Median length of stay was shorter for outpatients vs. inpatients (2 days vs. 4) and for pulmonary nodule vs. other indications (2 days vs. 3). Tobacco use did not affect length of stay or duration of tube thoracostomy. Epidural anesthesia was associated with shortened length of stay for outpatients and for patients with pulmonary nodule. Operative time was slightly longer (12.5 min) when a resident performed the operation.
Single-port thoracoscopy is a safe and useful procedure for a variety of diagnostic and therapeutic indications. Length of stay depends on indication for sVATS and inpatient vs. outpatient status; it may be shortened by use of epidural anesthesia.
Program Number: P407