Early Experience With Video-assisted Thoracoscopic Surgery In Nigeria

Olugbenga Oluseyi Olusoji1, Ezekiel Olayiwola Ogunleye1, Augustine Jeremai Olugbemi2, Olugbenga Olalekan Ojo2, Saheed Babatunde Sanni2, Oluwaseye Francis Akerele2

1. Cardiothoracic Surgery Unit, Lagos University Teaching Hospital/College of Medicine of University of

Lagos, Idi-Araba, Lagos

2. Cardiothoracic Surgery Unit, Lagos University Teaching Hospital, Idi-Araba, Lagos

Correspondence to: Dr. Saheed Babatunde Sanni Email: sannisaheed@yahoo.com 

Received: 15 Jan 2020; Revised: 8 Jun 2021; Accepted: 13 Jun 2021; Available online: 16 Aug 2021

Abstract

Background: Video-assisted thoracoscopic surgery (VATS) is a minimal access surgery that can be used for various diagnostic and therapeutic procedures. However, this tool is underused in our setting because of various reasons, ranging from equipment availability to expertise. Objective: This study aimed to review our early experience with VATS, highlighting the clinical attributes, outcomes, and challenges in our setting. Methods: This was a retrospective study of patients who underwent VATS between November 2015 and May 2019. Patients’ demographics, clinical presentation, diagnosis, procedural success, complications, and length of hospital stay were analyzed. Results: The study included 25 patients (mean age, 41.26±12.78 years). The most common preoperative diagnosis was right catamenial pleural effusion. The conversion rate was 20%, and the average length of hospital stay was 3.4 days. Conclusion: The scope of VATS is very narrow in our setting. Only one center in Nigeria has reported their experience. Our early experience showed good success rate and minimal complications albeit longer hospital stay. The identified limitations to use of VATS include lack of investment in procurement of appropriate equipment and expertise, which need to be overcome.

 

Keywords: VATS, Thoracoscopy, Effusion, Endometriosis, Air leak


Ann Afr Surg. 2021 ; 18(4): 215-219 
DOI: http://dx.doi.org/10.4314/aas.v18i4.4
Conflicts of Interest: None
Funding: None
© 2021 Author. This work is licensed under the Creative Commons Attribution 4.0 International License 

Introduction

Thoracoscopy, by definition, refers to the technique of inserting an optical tool through a trocar in the thoracic cavity for diagnostic or therapeutic purposes, while video-assisted thoracoscopic surgery (VATS) conventionally refers to the more elaborate thoracoscopic surgical procedure performed by (thoracic) surgeons in a completely anesthetized and double-lumen-ventilated patient (1).

It is indicated, whenever the expertise is available, as an alternative approach to many diagnostic and therapeutic thoracic procedures. These have, however, been extended into performing major pulmonary, esophageal, and other mediastinal structures resections (2). Its main advantages are early postoperative recovery time, short hospital stay, less postoperative pain, and cosmesis. For a few years now, this approach has undergone a series of modifications and is still currently evolving.

However, the application of these innovative thoracic techniques is limited in our setting, as it has only been reported by one center in Nigeria. They operated 25 patients by VATS over a 5-year period (2008–2013), representing less than 10% of cases seen over that period (2). There are no robust local data available. This study was aimed at presenting our institution data and reviewing our early experience with VATS, highlighting the various pathologies amenable to VATS intervention, the technical challenges of the procedure, the clinical attributes of the patients, and the complications, duration of hospital stay, average costs of the intervention, and eventual outcome. in our setting within the period under review.

Methods

This is a retrospective analysis of patients who had VATS at our center between November 2015 and May 2019. All procedures were done under general anesthesia in lateral decubitus position (operated side up) with lung isolation via a double-lumen endotracheal tube. The three-port technique was used for the first 15 cases. The trocars were placed at the 8th intercostal space (ICS), mid-axillary line, for the camera port (with 12-mm threaded trocar) and the other two ports were placed in the 5th ICS anteriorly and posteriorly under vision based on the convenience of the surgeon and areas of pathology. For the other cases, the two-port technique was used, with the camera port placed as above and the second port was placed in the 5th ICS usually anteriorly, just medial to the anterior axillary line. This port can be extended if necessary, and an incision retractor was placed for workspace creation. Biopsies were taken from suspicious areas and sent for histology. This site is also used for conversion to minithoracotomy if necessary. The reasons for conversion to thoracotomy were documented. Postoperative pain management was achieved, with satisfactory outcome, with paracetamol and non-steroidal anti-inflammatory drugs for a few days. Patients’ demographics, clinical presentation, diagnosis, procedural success, complications, length of hospital stay, and follow-up data were studied. Data were then analyzed using Statistical Package for the Social Sciences version 22 (IBM Corp., Armonk, NY, USA). Descriptive statistics were presented as means, percentages, and figures. The Student’s t-test was used to compare continuous variables, and the χ2 or Fisher’s exact test for categorical variables. A p-value <0.05 was considered statistically significant.

Results

Twenty-five patients (mean age, 41.26±12.78 years; age range, 22–65 years) underwent VATS between November 2015 and May 2019. Most patients were within the age group of 31–40 years (Table 1). The male/female ratio was 1:11.5. The most common preoperative diagnoses were right catamenial pleural effusion (first episode) (24%) and right malignancy-associated pleural effusion (8%). The average surgery duration was 150 minutes (range, 90–280 minutes).

Click to view Table 1: Patient characteristics, histological diagnosis, and complications (n=25)

 

Procedures performed were effusion drainage, lung parenchymal tumor and/or pleural biopsy, mechanical pleurodesis, decortication, and