Pulmonary biopsy by video assisted thoracic surgery: experience of 76 cases

RESUMO

VATS (Video Assisted Thoracic Surgery) has been progressively more utilized in General Thoracic Surgical. Among its several applications there is the possibility of performing pulmonary biopsy in diffuse lung diseases previously performed by open thoracotomy. VATS presents some disadvantages such as the use of sophisisticated equipment and includes advantages as the use of minimal incisions, optimal visualization of the lung and better adequate choice of the place to be biopsied. Between June/92 and Febuary/95, 76 pacients were submetted to pulmonary biopsy by VATS. The age ranges from 19 to 72 years (mean 47), 57 percent male. The most common indications for biopsy were interstitial fibrosis and interstitial pneumopathy. Two main techniques were used.In one a stapler was used to simultaneously resect the biopsy specimen and suture the parenchyma. This techniques was utilized in 72 percent of the patients. The second technique employed was and endo-loop suture (Vicryl 1 - Ethicon) to carry out the parechyma suture and was utilized in 24 percent of the patients. In 2 percent of the cases, in which there was good lung ealsticity, it was done through external traction biopsy and parenchyma suturing with 5.0 polypropylene. The biopsy site was chosen with the scope. In one patient (2.2 percent) it was not possible to perform VATS due to adhesions between the lung and the chest wall, therefore an open conventional biopsy was done. The histological diagnosis was obtained in all patients. The results showed interstitial fibrosis, pneumonia (or pulmonary infectious disease), pulmonary hypertension, honeycombing and chronic pneumopathy. There were no complications related to the used methols. Two patients (4.4 percent) died in the postoperative period due to previously existing pathology. In conclusion, VATS has proven to be a good, and minimally invasive method for lung biopsy, permitting the choice of the best place to perform the biopsy with effective histological diagnosis.