The Feasibility Of Two-port Complete Video-assisted Thoracoscopic Surgery For Benign Thoracic Diseases

Objective To evaluate the feasibility and safety of video-assistedthoracoscopic surgery (VATS) with two incisions for benign thoracicdiseases.Methods From July2009to June2013, a total of215patients (male128,female87; mean age46years old, rang15-80) underwent thoracoscopicsurgery for benign thoracic diseases in our department. The acceptingcriteria included:(a) Preoperative examination without liver and kidneydysfunction, but heart and lung function and general condition of thepatients could tolerate general anesthesia and surgery;(b) The patientswere diagnosed with benign lung lesions and mediastinal diseases beforeoperation or intraoperative pathology;(c) The patients with primaryspontaneous pneumothorax required surgery. The exclusion criteria included:(a) Preoperative examination with liver and kidney dysfunction or heartand lung function and general condition of the patients could not tolerategeneral anesthesia and surgery;(b) The patients suffered from empyema orchest CT showed pleural thickening or calcification;(c) Extensive lunglesions involving multiple lobes or bilateral lung lesions with thepatients required surgery at the same time;(d) The patients were convertedto thoracotomy due to hemorrhage or intense pleural adhesions. Among thesepatients,133patients (22lobectomy,32wedge resection,42primary spontaneous pneumothorax,37benign mediastinal mass) were treated usingtwo incision method (two-incision VATS), whereas82patients (20lobectomy,17wedge resection,21primary spontaneous pneumothorax,24benignmediastinal mass) were treated using the conventional3-port method(3P-VATS).Results There was no statistically significant difference in theduration of surgery, blood loss, duration of postoperative drainage andhospital stay in two-incision VATS group compared with the conventional3-port VATS group (P＞0.05). However, the pain scores on the visual analoguescale (VAS) on postoperative days1,3, and7were significantly higherin patients who underwent the conventional3-port VATS compared with thosewho underwent two-incision VATS (p=0.023,0.008, and0.046, respectively).The postoperative pains and abnormal feelings in patients who underwenttwo-incision VATS were significantly reduced.Conclusions Two-incision VATS is safe and reliable for benign thoracicdiseases. Our present experience demonstrated that two-incision VATS notonly decreased surgical incision and postoperative pain, but also resultedin higher patient satisfaction and cosmetic superiority compared with theconventional3-port VATS. Moreover, The realisation of two-incisions VATSshould neither prolong estimated operative time nor increase the operativedifficulties and the likelihood of surgical or postoperative complications.It can be used as the surgical method of choice for most benign thoracicdiseases.