Thoracoscopy makes visualisation of the intrathoracic structures possible and thus enables visually guided biopsies, resections or other surgical procedures to be undertaken without a major thoracotomy. This presentation is based on a retrospective study of eight years of VATS. We shall only discuss the role of thoracoscopy in the diagnosis and treatment of mediastinal and pleural diseases.
A. Pleural diseases
The conditions of the pleura that might benefit from thoracoscopy include pleural effusion, pleural mass or thickening, supected mesothelioma, empyema, hemothorax and chylothorax.. The thoracoscopic procedures that can be performed for pleural disease include pleural biopsy, drainage of a pleural effusion, pleurodesis, pleurectomy, drainage and debridement for early empyema, ligation of the thoracic duct for chylothorax, and exploration for hemothorax.
The indications of VATS in nineteen patients with a pleural mass and forty three patients with a pleural effusion will be discussed.
17 patients with a pleural mass had a proven lung cancer. In two patients there was no endobronchial or parenchymal lesion. 1. In cases of a non-disseminated lung cancer, it falls to the surgeon to prove the absence of pleural metastases prior to undertaking a resection. 2. For a patient who presents a pleural mass without endobronchial or parenchymal lesion, thoracoscopy is an ideal method both for harvesting material for diagnostic purposes and for therapeutic purposes, if one will execute a pleurectomy.
The 43 patients with a pleural effusion are divided into three groups. In 21 patients the indication for thoracoscopy was a pleural effusion without a parenchymal lesion, in sixteen the reason was a traumatic hemothorax and in six a chylothorax. The advantages and the technique of the thoracoscopic approach and its advantages are discussed.
B. Mediastinal Diseases
Mediastinal tumours are rare. Thoracoscopy for the diagnosis and management of these masses is now possible. However, the role of thoracoscopy in this setting still remains controversial. If one is not able to make a definitive preoperative diagnosis of a mediastinal mass, then it should be removed. If a confident preoperative diagnosis is made the decision to remove the lesion depends on the surgical problems that can be expected. The indications and the thoracoscopic approach in six patients is represented.