From the Guidelines
VATS decortication is the preferred surgical approach over open thoracotomy decortication due to its association with shorter hospital stays, less postoperative pain, and lower complication rates, as evidenced by a recent study published in 2023 1. The main difference between open thoracotomy decortication and VATS (Video-Assisted Thoracoscopic Surgery) decortication lies in the surgical approach, with VATS being less invasive and resulting in better clinical outcomes. Some key differences between the two approaches include:
- Length of hospital stay: VATS is associated with a shorter hospital stay, with a mean difference of 2.3 days compared to open thoracotomy decortication (95% CI: 1.2 to 3.4) 1.
- Postoperative pain: VATS is associated with less postoperative pain compared to open thoracotomy decortication, although a meta-analysis was not possible due to differences in data reporting formats 1.
- Complications: VATS is associated with a lower rate of complications, with 152 complications per 1000 patients compared to 197 complications per 1000 patients with open thoracotomy decortication 1.
- Mortality: VATS is associated with a slightly lower mortality rate, with 35 deaths per 1000 patients compared to 47 deaths per 1000 patients with open thoracotomy decortication 1. Overall, the choice between open thoracotomy decortication and VATS decortication should be based on individual patient factors, disease severity, and surgeon experience, with VATS being the preferred approach when technically feasible due to its reduced morbidity and comparable efficacy.
From the Research
Differences between Open Thoracotomy Decortication and VATS Decortication
- The operative time for VATS decortication is statistically less than open thoracotomy decortication, with a mean difference of -36.89 minutes [ 2 ].
- Postoperative hospital stay is also shorter for VATS decortication, with a mean difference of -2.41 days [ 2 ].
- VATS decortication has a lower rate of prolonged air leak, with 9.7% compared to 17.1% for open thoracotomy decortication [ 2 ].
- Chest tube duration is shorter for VATS decortication, with a mean difference of -1.52 days [ 2 ].
- Morbidity and mortality rates are also lower for VATS decortication, with 16.4% and 4.1% respectively, compared to 24.5% and 6.2% for open thoracotomy decortication [ 2 ].
Clinical Outcomes
- VATS decortication has superior outcomes in terms of postoperative morbidity, complications, and length of hospital stay [ 3,4 ].
- VATS decortication results in reduced postoperative pain, atelectasis, prolonged air-leak, sepsis, and 30-day mortality [ 3,4 ].
- The conversion rate from VATS to open thoracotomy is relatively low, ranging from 0-17.1% [ 3,4,5 ].
Treatment of Empyema
- VATS decortication is a safe and effective approach for the treatment of pleural empyema, with a high success rate and low morbidity [ 5,6 ].
- Ultrasonographic preoperative staging can help identify patients who are suitable for VATS decortication [ 5 ].
- VATS decortication may be recommended as a first-line therapy in early stage multiloculated empyema thoracis [ 6 ].