Prospective Observational Study for Role of Thoracoscopic Diagnosis and Treatment of Intrathoracic Pathology

Abstract This prospective observational study was conducted at the Department of General Surgery in our tertiary care center, from March 2022 to August 2024, enrolling 47 patients fitting inclusion criteria. The aim was to evaluate safety, efficacy and effectiveness of VATS. Video-Assisted Thoracoscopic Surgery is a minimally invasive procedure. Within a short period, VATS became common among thoracic surgeons. Its application has seen a steady increase in terms of its diagnostic and therapeutic utility. The age distribution analysis indicates a younger demographic in the present study, 63.8% cases undergoing VATS were belonging to 21 – 40 years of age group. The study consistently shows a higher prevalence of males (69%) undergoing thoracic procedures (VATS), suggesting a gender disparity in the incidence or management of thoracic conditions. (Male: Female ratio 2.13:1). Cough (65.9%) was most prevalent symptoms followed by Fever & Dyspnoea. In the present therapeutic interventions are the primary focus, representing 46.8% of cases. followed 38.3 % diagnostic and therapeutic and 14.9 % only for diagnosis. Reflecting a shift towards managing established conditions with our gaining experience and confidence in VATS procedures, therapeutic applicability is on the rising trend. The VATS is reliable and its ability to provide accurate diagnoses (97.9%) across different intra-thoracic pathologies. Whereas one case undiagnosed due to improper tissue processing. Empyema was most prevanalence, which constitutes 31.9% of cases; followed by PE and bullae accounting 23.4% and 10.64% respectively. However 17 % of VATS cases converted to open thoracotomy due to intra operative diffused bleeding (which obscured the visual field), thick and adhered pleura and difficulties to access lesion. The average blood loss in VATS 247 ml was noticed. 20.5% of VATS were completed in under 90 minutes, 33.3% between 90-120 minutes, 28.2% between 120- 150 minutes & 17.9 % took longer than 150 minutes; however, the average & mean operative time was 119 minute and 127.2 minute respectively. Complications encounter in VATS, in intraoperatively (17.95% cases) three cases of bleeding (7.69%), one case of hypotension (2.56%), two cases of thick adhesions (5.13%), and one case of crowding of ribs (2.56%). In contrast to postoperative complication suture site infection is most common constitutes 7.96%, with hypotension, air leak, & recurrence of emyema (2.56% each). Following the VATS 38.5% patients were discharged in less than 7 days, 46.2% stayed between 7 and 14 days, and 15.4% remained hospitalized for more than 14 days( 3 patients due to suture site infection, two cases due to recurrent empyema & one due to air leak). The pre-operative and post-operative PFT (FEV1 and FVC). The average FEV1 increased by 9.8 L, and the average FVC increased by 9.5 L post operatively. This improvement indicates that the surgeries were effective in enhancing lung function. In contrast with converted open thoracotomy (17%) 8 cases; open surgery has more invasive & longer operative time (average operative time-150 minutes), higher complication rate (intraoperative-62.5%, postoperative-61.25%), longer recovery time, requires longer hospitalization (average-11.13 days). Despite of above mentioned factors open thoracotomy is useful in large tumor resection, difficulty in VATS.