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Anthony P. C. Yim
Hui-Ping Liu
Stephen R. Hazelrigg
Mitchell J. Magee
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Ann Thorac Surg 1998;65:328-330
© 1998 The Society of Thoracic Surgeons

Original Articles: General Thoracic

Thoracoscopic Operations on Reoperated Chests

Anthony P. C. Yim, MD, Hui-Ping Liu, MD, Stephen R. Hazelrigg, MD, M. Bashar Izzat, FRCS, Alex L. K. Fung, BA, Theresa M. Boley, MSN, Mitchell J. Magee, MD

Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong;
Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan;
Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA

Accepted for publication August 15, 1997.

Dr Yim, Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, Shatin, New Territories, Hong Kong (e-mail: yimap@cuhk.edu.hk).

Background. A previous operation is generally considered to be a relative contraindication to the minimal access approach. We reviewed our combined experience from three centers with video-assisted thoracic surgery on reoperated chests.

Methods. From September 1992 to December 1996, 2,477 patients underwent video-assisted thoracic surgery of whom 40 patients (33 men; age range, 9 to 78 years) had prior operations on the ipsilateral side of the chest: 23 after prior open procedures (22 thoracotomies, 1 median sternotomy) and 17 after video-assisted thoracic surgery. The second procedures consisted of bullectomy or bulla ligation (8), mediastinal and hilar mass biopsy (8), wedge lung resection (6), pericardial window (5), lung volume reduction (4), redo thoracodorsal sympathectomy (3), talc insufflation alone (3), decortication (2), and suturing of a pleural rent (1).

Results. Adhesions were noted in all patients ranging from minimal to strong fibrous adhesions. However, in only 2 patients (5%) were the procedures abandoned because of adhesions. Video-assisted thoracic surgery was safely completed in all other patients. There was no mortality or intraoperative complications and mean hospital stay was 5.1 ± 3.2 days (range, 0 to 17 days).

Conclusions. Video-assisted thoracic surgery on reoperated chests is feasible and does not carry a higher morbidity or mortality compared with first-time operations, even though it may be technically more difficult. Experience and clinical judgment, however, are required to select these patients for reoperation with video-assisted thoracic surgery.






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