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The Journal of Thoracic and Cardiovascular Surgery, Vol 106, 194-199, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
PF Ferson, RJ Landreneau, RD Dowling, SR Hazelrigg, P Ritter, S Nunchuck, MK Perrino, CM Bowers, MJ Mack and MJ Magee
BACKGROUND: Patients with diffuse pulmonary infiltrates often require
biopsy for a diagnosis. Standard operative therapy, open wedge resection
via thoracotomy, is associated with known morbidity. We hypothesized that
closed thoracoscopic wedge resection may result in reduced morbidity and
decreased duration of hospital stay. This retrospective study compares open
resection with thoracoscopic wedge resection in patients with diffuse
pulmonary infiltrates. METHODS: Seventy-five patients with diffuse
pulmonary infiltrates underwent diagnostic lung biopsy. Patients requiring
mechanical ventilation and high levels of pressure support before biopsy
were excluded from the study. Between March 1987 and September 1991, a
total of 28 patients underwent open wedge resection via lateral
thoracotomy. Since April 1991, a total of 47 patients underwent
thoracoscopic resection. RESULTS: There was no difference between the
groups in age, sex, presence of immunosuppression, or final pathologic
diagnosis. Adequate tissue was obtained for pathologic diagnosis in all
patients of both groups. All surgeons believed that thoracoscopic biopsy
provided better visualization of the entire lung than did a limited
thoracotomy. Mean operative time was 69 minutes for open biopsies and 93
minutes for thoracoscopic biopsies [p = 0.038]. Mean duration of chest tube
drainage was not significantly different between the two groups. Duration
of hospital stay was significantly less for thoracoscopic biopsy (4.9 days)
than for open biopsy (12.2 days) (p = 0.018). Fourteen of 28 open biopsies
resulted in complications compared with 9 of 47 closed biopsies (p =
0.009). There were 6 deaths among patients having open biopsies and 3
deaths among those having closed biopsies (p = not significant).
CONCLUSION: A significant decrease in hospital stay was noted with
thoracoscopic biopsy when compared with lung biopsy via the standard open
approaches. Thoracoscopy provided excellent visualization and allowed for
wedge resection that provided adequate tissue for diagnosis in patients
with diffuse pulmonary interstitial disease.
ARTICLES
Comparison of open versus thoracoscopic lung biopsy for diffuse infiltrative pulmonary disease
Section of Thoracic Surgery, University of Pittsburgh, PA 15213.
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