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The Annals of Thoracic Surgery, Vol 56, 1285-1289, Copyright © 1993 by The Society of Thoracic Surgeons
RJ Landreneau, SR Hazelrigg, MJ Mack, RD Dowling, D Burke, J Gavlick, MK Perrino, PS Ritter, CM Bowers and J DeFino
One hundred thirty-eight consecutive, nonrandomized patients, with
equivalent demographic and preoperative physiologic parameters, underwent
either a video-assisted thoracic surgical (VATS) approach (n = 81) or a
limited lateral thoracotomy (LLT) approach (n = 57) to accomplish pulmonary
resection for peripheral lung lesions (< or = 3 cm in diameter). Wedge
resection was done in 74 VATS patients and 19 LLT patients. Seven patients
underwent VATS lobectomy and 38 patients had lobectomy performed through an
LLT. Pain was quantitated by postoperative narcotic requirements, the need
for intercostal/epidural analgesia, and patient perception of pain index
scoring. Shoulder and pulmonary function (forced expiratory volume in 1
second) were measured preoperatively, 3 days postoperatively, and at 3
weeks of follow-up. Patients undergoing VATS experienced significantly less
postoperative pain. No patients undergoing VATS required intercostal
block/epidural analgesia; 31 LLT patients (54%) required this treatment for
breakthrough pain (p = 0.001). Narcotic requirements were less (p = 0.05)
among VATS patients, which correlated with lower perception of pain index
after operation for VATS patients. Shoulder girdle strength was equally
impaired at day 3, but function was more improved in VATS patients at 3
weeks (p = 0.01). Patients undergoing wedge resection alone by LLT had
greater impairment in early (day 3) pulmonary function (forced expiratory
volume in 1 second) (p = 0.002); this difference from VATS was not
sustained at 3 weeks. Video-assisted thoracic surgery is associated with
reduced pain, shoulder dysfunction, and early pulmonary impairment compared
with LLT for select patients requiring pulmonary resection.
ARTICLES
Postoperative pain-related morbidity: video-assisted thoracic surgery versus thoracotomy
Section of Thoracic Surgery, University of Pittsburgh, Pennsylvania 15213.
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O. Rena, C. Casadio, F. Leo, R. Giobbe, R. Cianci, S. Baldi, M. Rapellino, and G. Maggi Videothoracoscopic lung biopsy in the diagnosis of interstitial lung disease Eur. J. Cardiothorac. Surg., December 1, 1999; 16(6): 624 - 627. [Abstract] [Full Text] [PDF]
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M. T. Jaklitsch, R. Bueno, S. J. Swanson, S. J. Mentzer, J. M. Lukanich, and D. J. Sugarbaker New Surgical Options for Elderly Lung Cancer Patients* Chest, December 1, 1999; 116(suppl_3): 480S - 485S. [Abstract] [Full Text] [PDF]
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