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Ann Thorac Surg 1995;60:934-935
© 1995 The Society of Thoracic Surgeons

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Discussion

Discussion

The first 300 words of the full text of this article appear below.

See also page 931.

DR JOSEPH I. MILLER, JR (Atlanta, GA): Doctor Cole, I appreciate your asking me to discuss your paper and the opportunity of receiving the manuscript before presentation. I rise mainly to second your conclusions. Basically when VATS became available at a national level in 1991, enthusiasm was quite high in the utilization of this technique, potentially in the role of spontaneous pneumothorax, and I, like a number of other people around the country, employed this initially in our practice. However, it was in the calendar year 1992 I received my first, not my own but a recurrence, and then during the calendar year I reoperated on 7 patients from outside the Emory system with the conventional techniques who had failed VATS done in the state of Georgia. That led to my own conviction that VATS was probably not better than the usual axillary thoracotomy for this situation.

During 1992 and 1993 I had the opportunity to give the talk at the World Congress on Thoracoscopy on complications of VATS, and Dr Steven Hazelrigg provided me access to data from the VATS study bank. The national failure rate of VATS is around 7%, with up to a 10% failure rate reported.

In this particular application of VATS, it was hard for me to see where three 1-cm incisions were any different than, say, a 7- to 9-cm incision through the standard axillary approach. In a personal operative experience at Emory over a 20-year period I had 176 patients either through axillary thoracotomy or limited thoracotomy with no recurrence rate and no operative mortality.

It is hard for me to think that we should take an operation that has essentially a 100% success rate, that is, when done by conventional methods by either of the other . . . [Full Text of this Article]

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Video-Assisted Thoracic Surgery: Primary Therapy for Spontaneous Pneumothorax?

F. Hammond Cole, Jr, Francis H. Cole, Alim Khandekar, J. Matthew Maxwell, James W. Pate, and William A. Walker
Ann. Thorac. Surg. 1995 60: 931-933. [Abstract] [Full Text]