Article Abstract

Video-assisted thoracic surgery (VATS): impressions from members of the Brazilian Society of Thoracic Surgery

Authors: Ricardo Mingarini Terra, Thamara Kazantzis


Background: Video-assisted thoracic surgery (VATS) is a well-established technique for lung and pleural interventions and it has been widely spread around the world. In Brazil, a developing country, its implementation is fairly recent and there are doubts on its feasibility and on how Brazilian surgeons feel about it. This study’s main objective is to portrait the current setting of VATS’ use in anatomic pulmonary resections in Brazil, analyzing the characteristics of thoracic surgeons that apply this method in their practice, their technical features and their difficulties with the method. We also aimed to define how many surgeons perform VATS and how they are distributed across the country, as well as their perceptions about VATS and the barriers for its throughout implementation in our environment.
Methods: The members of the Brazilian Society of Thoracic Surgery (BSTS) were invited through electronic mail to participate in a survey approaching several aspects of VATS. Questions about VATS’ techniques, costs, pitfalls and applications were inquired through an online survey using the REDCap™ software. Participants had their identities preserved through a coding system.
Results: Two hundred and twenty-four thoracic surgeons answered the survey, including 219 (97.7%) complete answers and 5 (2.3%) incomplete answers. There were 209 men (93.3%), mean age was 44.24 years (29–76 years, SD 10.5). Most participants (n=153, 68.3%) performed at least one VATS lobectomy. However, only 84 surgeons perform VATS lobectomy over traditional thoracotomy in more than 30% of their procedures. Surgeon’s annual volume of lobectomies positively influenced chances of performing VATS (OR 1.04; 95% CI, 1.01–1.07; P=0.004), as did the place where the surgeon performs: cities with more than one million inhabitants increased the chance of performing VATS (OR 2.58; 95% CI, 1.27–5.24; P=0.009). Median volume of lobectomies per year was 20. One hundred and twenty-eight surgeons perform their activities in cities with more than a million inhabitants, 72 surgeons are in cities with less than a million inhabitants and 24 participants did not inform their cities. Participants found logistic and financial issues to be the main reasons for VATS not to be completely implemented in our country, followed by lack of training programs.
Conclusions: The majority of Brazilian thoracic surgeons have performed at least one VATS lobectomy even though this still represents the smaller percentage among all procedures. Financial and logistic issues were found to be the main responsible for the difficulties of fully implementing VATS in our country.