| The clinical practice of thoracoscope on the thorax surgery dates from 1910.Jacobaeus, a physician of Sweden,first performed thorax adhesiotomy to treat pulmonary tuberculosis mainly by thoracoscope. In the 1980s, with the development of optics technology, especially the endoscope video technology, thoracoscope and its complementary equipment was becoming more perfect. This makes the traditional thoracoscope develop into the modern video-assisted thoracic surgery,VATS. At present, it is not only performed at the diagnosis of thoracic diseases, but also performed from the simple surgical treatment, such as the pleural disease,etc. firstly to complex surgical treatment, such as early stage esophagus cancer,early stage lung cancer, mediastinum diseases, etc.First, about the clinical diagnosis of common malignant hydrothorax, its positive diagnosis rate is low by pleurocentesis and biopsy. According to the statistics collected by some scholars the postive rate were 22% and 26% respectively. While VATS can not only explore the thorax overall,but also obtain the pathological changed organization accurately.lt can improve the rate of definite diagnosis, and compartmentalize the malignant tumour by clinical stage accurately. Reported in literature, the diagnosis rate of malignant hydrothrax by VATS is up to 93 — 96%. Meanwhile, VATS has exact curative effect on maligrant hadrothorax.Especially by spraying sterilized talc powder to pleura by VATS to treat malignant hydothorax, its curative rate may be up to 93%. So the VATS can make an exact diagnosis of the malignant hydrothorax, and offer basis for further treatment,and improve the patient's existence quality in oder to make the opportunity to treatfurther as well.Second, in early stage of chronic pyothorax, there is a lot of purulent necrotic organization in the thorax cavity.After the conservative treatment of repeated thoracentesis or the thorax drainage, there may form an enwrapped pyothorax and a lot of fibre cellular in the thorax cavity.Fibre membrane taking shape around lung surface, treating with antibacteria therapy,thorax puncturing,thorax drainage and thorax washing needs a long hospital stay,and the curative effect is poor.While treating by VATS can remove pus and netrotic orgnization under direct-view, open the purulent fibre cellular, strip purulent fibreboard, and make lung re-expand completely. Treating chronic pyothorax in early stage by VATS has the virtues of less agony, shorter hospital stay, more favorable effects, etc.Third, VATS has already been considered the first method to treat spontaneous pneumothorax. Routine VATS treatment of spontaneous pneumothorax is often performed under general anethesia and double-current catheter endotracheal tube.Some scholars have excised bullous to treat spontanous pneumothorax under local anethesia and using calmative. It is suitable especilly for the serious primary pneumonosis patients, who can't be tolerant under general anethesia with only one side lung working.It's safer that the treatment of spontaneous pneumotherax is performed by VATS under local anethesia. The advantages are as follows: (1) it can avoid the complication of general anethesia; (2)patients can talk with doctors under operation so as to help finish the operation; (3)they can recover fast after operation and take food earlier as well; (4)the expense of the double-current catheter endotracheal tube can be reduced.But the patients should be chosen strictly.This method is only suitable for the patient without pleura adhesion, whose location of the bullous is accurate before operation, especially for those who have single bullous and uncomplicated operating. And the patients can't tolerate general anethesia with only one lung working.There are other scholars who excise bullous to treat spontaneouspneumothorax with two-hole method and that has been proud ro be effective. The advantages of the method are as follows: (j)the operation is simplified; ?the operative wound is abated; ?the operation expense is reduced greatly with the ordinary apparatus and the curative effect is precisely reliable.Fourth, there are some different views and disputes on the treatment of the thorax malignant diseases by VATS. But it is technically feasible that the pneumonectomy is performed by VATS, whether on clinical practice or on reports from the thorax doctors.On the operation the additional minimal incision is often adopted, which can help perform pneumorectomy and lymph node excision safely, so that it will be consistent with the basic principle of surgical therapeutics of lung tumor even more. The operative indication approved relatively at present is as follows: ''.Dearly non-small-cell lung cancer, ?the patients in stage I b^IIIa non-small-cell lung cancer, whose lung function are poor and cannot tolerate incising chest operation, may be chosen to perform lobectomy or wedge excision; (3) lung cancer with malignant hydrothorax may be performed with pleuroparietopexy by VATS. (4)lung cancerometastasis with the diameter shorter than 3.0cm; long diameter but only one or multiple cancerometastasis but in only one lobe.The fifth, in a few developed countries , VATS has already become the first-selected treatment method to the benign esophagus disease. Reports from foreign documents show that the radical operation of esophagus cancer by VATS should be feasible. Some internal scholars reported 68 cases of esophagus cancer radical operation by VATS.They thought that the lymph node recection was easy at the radical operation of esophagus cancer, and they have made satisfactory result.Yet, there is no unanimous opinion at present in the indication of the radical operation of esophagus cancer by VATS. Wang jun thought VATS could reach the purpose of radical cure to the patients in the early or medium stage esophagus cancer. Qin DuXiang thought VATS couid treat esophagus cancer under the length of 5. 0cm and without soft tissue shade on the bariumopacification radiogram;or esophagus cancer growing mainly in the esophagus cavity. All above can be regarded as the VATS indication.A domestic scholar has performed an operationon a group of patients suffering esophagus cancer by the improved VATS and made satisfactory result. He thought that the VATS indication of esophagus cancer has been expanded by the improved VATS.The sixth, VATS has been demonstrating its advantages gradually in diagnosis and treatment of the mediastinum tumor.Medastinum tumor is various in style, and is uneasy to distinguish with the cancerometastasis of mediastinal lymph node and nodosity diseases, etc. Led by B ultrasonic wave and CT,pleurocentesis biopsy is unable to make a definite diagnosis sometimes. While by VATS, there is enough tumor organization obtained under direct-view,and precise diagnosis can be made. The operative indication1 of mediastinum tumor is as follows: ?mediastinum cyst; ?the substantive benign mediastinal tumor with intact bag membrane and diameter shorter than 6.0 cm.The malignant mediastinum tumor is not fit for VATS yet at present.There are still a lot of dispute on myasthenia gravis thymectomy by VATS. To treat the disease, thymectomy should be completely done,and the operation is able to be performed completely by VATS technically. Mineo reported 31 cases thymectomy by VATS and its effective rate was 96% after following up during 16-75 months. Mack reported 33 cases and its effective rate was 87. 9%(29/33). Its curative effect is similar to that of the other operative methods.The seventh, as to complicated chest traumatism, VATS, which is applied at clinic, can perform thorax cavity exploration with minimal operative damage.It avoids the agony of big incision and some chest traumatism can be treated with minimal operation by VATS.The eighth, VATS is of minimal damage, short recovery,but it may also bring the operative complication if used improperly.The causesof VATS complication are as follows: ?indequate experience; ?no enough control over the symptoms of the primary disease; ?complication before operation;?not having enough using apparatus experience.The prevention and cure of the complication lies in the following several respects: ?the choice of the indication should be proper; ?paying attention to the prevention and cure of bleeding and internal organs damage on operation; (3) the necessity of the additional minimal incision and turning to thoracectonly on the VATS.The limitations of VATS should be realized adequately, and VATS cannot replace the classical thoracectomy totally. The basic points to prevent, VATS complication are abundant clinical experience, strict operative indication and prudent performance during the operation. |
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