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J Thorac Cardiovasc Surg 1995;109:1255-1256
© 1995 Mosby, Inc.
BRIEF COMMUNICATIONS |
Hong Kong
From the Cardiothoracic Unit, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
Landreneau and associates
1 recently concluded from their study that the prevalence of long-term chronic pain after an apparently less traumatic procedure to the chest wall is not significantly different from that after thoracotomy.
Intuitively, one might think that the trauma to the chest wall during video-assisted thoracic surgery (VATS) should be comparable with the trauma of placing a large-bore chest tube. Yet, why are we seeing so many more patients with chronic pain after VATS than after chest tube insertion? Among our patients with chronic pain after VATS, the majority have dysaesthesia along the thoracoabdominal dermatomic distribution of the intercostal nerve (usually involved at the camera port) rather than at the incision sites. Although most Chinese patients have a thinner chest wall, their relatively smaller stature compared with the white population means that they also have smaller intercostal spaces. Even moderate torquing of the thoracoscope through a 10.5 mm port placed low in the chest over a period of time could result in significant trauma to the intercostal nerve. We have found the following maneuvers to be useful in our practice.
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Footnotes
J THORAC CARDIOVASC SURG 1995;109:1255-6 ![]()
References
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