Video-Assisted Thoracic Surgery Is Minimally Invasive, But Is It Less Traumatic?

Abstract

Background: Video-assisted thoracic surgery (VATS) is a minimally invasive procedure. This study aimed to evaluate whether the procedure is less traumatic to the ipsilateral non-diseased lobe(s) than open thoracotomy (OT) during pulmonary resection by a comparison of alveolar-capillary membrane (A/C) permeability. Methods: Wedge resections were performed in twenty-seven patients with various types of primary and secondary malignant, solitary, pulmonary nodules. Fifteen patients had OT, while 12 patients had VATS. ^{99 m}Tc-DTPA radioaerosol studies were performed on the day before surgery and on the third or fourth day postoperatively. The images of the ipsilateral non-diseased lobe(s) were compared. Results: Postoperatively, all patients had significantly increased A/C permeability at the ipsilateral non-diseased lobe(s). However, the degree of increase in the VATS group was the same as that of the OT group. Postoperative A/C permeability of the contralateral lung was not significantly different. Conclusions: Both procedures caused injury to the ipsilateral non-diseased lobe(s) in terms of A/C permeability at the same degree. Although VATS has been considered as a minimally invasive procedure, the trauma caused by VATS to the “disease-free lung” is the same as that caused by open thoracotomy.

Key words

Video-assisted thoracic surgery - alveolar-capillary permeability

References

• 1 Yim A P, Lee T W, Izzat M B, Wan S. Place of video-thoracoscopy in thoracic surgical practice.  World J Surg. 2001;  25 157-161
• 2 Kirby T J, Mack M J, Landreneau R J, Rice T W. Lobectomy: video-assisted thoracic surgery versus muscle-sparing thoracotomy. A randomized trial.  J Thorac Cardiovasc Surg. 1995;  109 997-1001
• 3 Robert J, McKenna Jr. Video-assisted thoracic surgery for wedge resection, lobectomy, and pneumonectomy:. Shield TW, Locicero III J, Ponn RB, Rusch VW General Thoracic Surgery. 6th ed. Philadelphia; Lippincott Williams & Wilkin 2005: 524-532
• 4 Walker W S, Pugh G C, Craig S R, Carnochan F M. Continued experience with thoracoscopic major pulmonary resection.  Int Surg. 1996;  81 255-258
• 5 Landreneau R J, Mack M J, Hazelrigg S R. et al . Prevalence of chronic pain after pulmonary resection by thoracotomy or video-assisted thoracic surgery.  J Thorac Cardiovasc Surg. 1994;  107 1079-1085
• 6 Sundram F X. Clinical studies of alveolar-capillary permeability using technetium-99 m DTPA aerosol.  Annals of Nuclear Medicine. 1995;  9 171-178
• 7 Suga K, Alderson P O, Mitra A. et al . Early retardation of ^{99 m}Tc-DTPA radioaerosol transalveolar clearance in irradiated canine lung.  J Nuclear Med. 2001;  42 292-299
• 8 Suga K, Yuan Y, Ogasawara N, Tsukuda T, Matsunaga N. Altered clearance of gadolinium diethylenetriamine penta-acetic acid aerosol from bleomycin-injured dog lungs.  Am J Respiratory & Critical Care Med. 2003;  167 1704-1710
• 9 Staub N C, Hyde R W, Crandall E. NHLBI workshop summary - workshop on techniques to evaluate lung alveolar-microvascular injury.  Am Rev Respir Dis. 1990;  141 1071-1077
• 10 Susskind H. Technetium-99 m - DTPA aerosol to measure alveolar-capillary membrane permeability.  J Nucl Med. 1994;  35 207-209
• 11 West J B. Thoughts on the pulmonary blood-gas barrier.  Am J Physiol Lung Cell Mol Physiol. 2003;  285 L501-L513
• 12 Whitwell K E, Greet T R. Collection and evaluation of tracheobronchial washes in the horse.  Equine Vet J. 1984;  16 499-508
• 13 Hopkins S R, Schoene R B, Henderson W R, Spragg R G, Martin T R, West J B. Intense exercise impairs the integrity of the pulmonary blood-gas barrier in elite athletes.  Am J Respir Crit Care Med. 1997;  155 1090-1094
• 14 Schoene R B, Swenson E R, Pizzo C J. et al . The lung at high altitude: bronchoalveolar lavage in acute mountain sickness and pulmonary edema.  J Appl Physiol. 1988;  64 2605-2613
• 15 Fu Z, Costello M L, Tsukimoto K. et al . High lung volume increases stress failure in pulmonary capillaries.  J Appl Physiol. 1992;  73 123-133
• 16 Wieslander J, Heinegard D. The involvement of type IV collagen in Goodpasture's syndrome.  Ann NY Acad Sci. 1985;  460 363-374
• 17 Jones J G, Minty B D, Lawler P, Hulands G, Crawley J C, Veall N. Increased alveolar epithelial permeability in cigarette smokers.  Lancet. 1980;  1 66-68
• 18 Mason G R, Uszler J M, Effros R M, Reid E. Rapidly reversible alterations of pulmonary epithelial permeability induced by smoking.  Chest. 1983;  83 6-11
• 19 Royston B D, Webster N R, Nunn J F. Time course of changes in lung permeability and edema in the rat exposed to 100 % oxygen.  J Appl Physiol. 1990;  69 1532-1537
• 20 Caner B, Ugur O, Bayraktar M, Ulutuncel N, Mentes T, Telatar F, Bekdik C. Impaired lung epithelial permeability in diabetics detected by technetium-99 m - DTPA aerosol scintigraphy.  J Nuclear Med. 1994;  35 204-206