Risk and hazards of video-thoracoscopic surgery: a collective review.
OBJECTIVE: Since 1990, video-thoracoscopy has rapidly gained widespread acceptance. In contrast to conventional thoracoscopy no comprehensive studies of potential risks and hazards have been carried out. To date interest has centered on possible indications and thoracoscopic techniques. Based on a review of the literature, this article summarizes and comments on possible complications. METHODS: In a meta-analysis (Medline, January 1989 until December 1994), all publications dealing with thoracoscopy were collected. Those papers concerned with video-thoracoscopy were further evaluated if the following criterias were fulfilled: first, the endoscopist employed a video-camera connected to the thoracoscope; second, separate entry sites were used for telescope and instruments. RESULTS: Of 345 papers, 145 met the above criterias, 5280 thoracoscopies could be analysed for more than 30 indications. The calculated mortality rate was 0.3% and the complication rate 3.61%. In 55 of all cases (1.04%), the intervention had to be converted to open surgery. CONCLUSIONS: Video-thoracoscopic thoracic surgery has gained acceptances as a complement to open thoracic surgery. It may now be regarded as a safe technique. Nevertheless, serious complications such as implantation metastasis of the thoracic wall after thoracoscopy or injury to the recurrent nerve demonstrate the complexity of thoracoscopic surgery. Practitioners should therefore be proficient in thoracic surgery. The importance of meticulous technique and rigid adherance to safety guidelines even in diagnostic procedures, must be stressed.