Page 181 - Clinical Manual of Small Animal Endosurgery

Chapter 6

Thoracoscopy

Romain Pizzi

Introduction

Many surgeons who work on humans prefer to refer to video-assisted
thoracic surgery (or VATS) instead of using the term thoracoscopic
surgery. This highlights one of the main benefits that endosurgery brings
to thoracic surgery: visualisation. The use of the term also recognises
that some procedures cannot be completed solely via thoracoscopy.
Enhanced visualisation can however help reduce wounds to a mini-
thoracotomy, without the need for rib retraction and the subsequent
associated postoperative pain. Even if still performing an intra-thoracic
procedure in a standard open technique, use of an endoscope can help
improve this with excellent illumination and magnified visualisation. The
ultimate aim of thoracoscopy should be safe, visual surgery, with the
secondary benefit of smaller wounds and resultant lower postoperative
morbidity. Small open thoracotomy incisions on their own just lead to
poor visualisation, and resultant unsafe surgery.
While minimally invasive thoracic surgery has benefits for the patient
in terms of reduced postoperative morbidity, there is notably also the
benefit for the veterinarian of reduced postoperative care. There is often
no need to maintain an indwelling chest drain postoperatively.
It should be obvious, as regards personal professional ethics as well
as veterinary jurisprudence, that one should not attempt to perform
thoracoscopic procedures unless already familiar with standard open
thoracotomy techniques. Thoracoscopy is not an alternative to standard
thoracic surgery, but a refinement. It still requires the same preoperative
assessment, diagnostics and decision making. Conversion to a standard

Clinical Manual of Small Animal Endosurgery, First Edition. Edited by Alasdair Hotston Moore and
Rosa Angela Ragni.
© 2012 Blackwell Publishing Ltd. Published 2012 by Blackwell Publishing Ltd.