Video-assisted thoracic surgery: Has technology found its place?
Video-assisted thoracic surgery: Has technology found its place?
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DOI：
10.1016/s0003-4975(97)00247-6
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发表时间：
1997-07-01
影响因子：
4.6
通讯作者：
Landreneau, RJ
中科院分区：
文献类型：
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作者：
Mack, MJ;Scruggs, GR;Landreneau, RJ
背景自1990年微创外科技术引入胸外科以来，电视胸腔镜手术（VATS）已成为许多胸外科手术的方法。VATS的作用在慢慢演变，但尚未明确界定。为了更好地理解VATS的作用，我们对执业胸外科医生进行了调查。我们向普通胸外科俱乐部的成员发送了一份调查问卷，询问VATS在他们的实践中的作用，以及他们对该方法的适当应用、优点和局限性的看法。229名成员中有200名（87.3%）回答了问卷。在这个主要是学术性的（66.3%）胸外科医生组中，72%的胸外科医生具有10年以上的普胸外科经验，VATS是治疗胸膜疾病、肺活检、复发性气胸和交感神经切除术的首选方法（>50%的反应）。大多数受访者认为，电视胸腔镜手术是一种可接受的方法，用于诊断不确定的肺结节和前、后纵隔肿块，并用于管理早期脓胸，凝血性血胸，继发性气胸，有限的肺癌治疗和良性食管疾病。对于胸腺切除术、肺叶切除术和肺减容术，大多数人认为视频辅助胸外科手术是不可接受的或研究性的。视频辅助胸外科手术仍然只占胸外科手术的一小部分，但其使用率逐渐增加，尽管38.1%的人表示担心过度使用。主要的局限性被认为是在肿瘤疾病的管理。看来，电视胸腔镜手术是一个有价值的除了胸外科的做法，但显着的局限性存在。虽然似乎有许多具体的适应症定义，仍然有一个重要的演变组成部分。
Background. Since the introduction of minimally invasive surgical techniques in thoracic surgery in 1990, video-assisted thoracic surgery (VATS) has become the approach for many thoracic operations. The role of VATS has slowly evolved but has not been clearly defined. To better understand the role of VATS, we undertook a survey of practicing thoracic surgeons.Methods. A questionnaire was sent to members of the General Thoracic Surgery Club asking the role of VATS in their practice and their opinions regarding appropriate applications, advantages, and limitations of the approach.Results. Two hundred of the 229 members (87.3%) responded to the questionnaire. In this largely academic (66.3%) group of thoracic surgeons, 72% of whom had more than 10 years experience in general thoracic surgery, VATS was the preferred approach (>50% response) for the management of pleural disease, lung biopsy, recurrent pneumothorax, and sympathectomy. A majority of respondents thought that VATS was an acceptable approach for the diagnosis of the indeterminate pulmonary nodule and of anterior and posterior mediastinal masses, and for the management of early empyema, clotted hemothoraces, secondary pneumothorax, limited lung cancer treatment, and benign esophageal disease. Video-assisted thoracic surgery was thought to be unacceptable or investigational by a majority for thymectomy, lobectomy, and lung volume reduction operations. Video-assisted thoracic surgery still represents only a small portion of the thoracic procedures performed, but there is a gradual increase in its rate of use, although 38.1% expressed concern regarding overuse. The main limitation was thought to be in the management of oncologic disease.Conclusions. It appears that VATS is a valuable addition to the practice of thoracic surgery, but significant limitations exist. Although there appear to be many specific indications defined, there is still a significant evolutionary component.