ABSTRACT
Introduction .......................................................................................................................... 194 Port Site Recurrence............................................................................................................ 194 Pathophysiology o f Tumor Im plan ts ................................................................................. 195 Acute P ain .............................................................................................................................. 196 Chronic P a in ............................................................................................................................196 Im m une R esponse ................................................................................................................ 197
INTRODUCTION
Videothoracoscopy, or video-assisted thoracic surgery (VATS), represents a major advance in thoracic surgery in the last decade. VATS, compared to conven tional thoracotomy, produces less postoperative pain, shorter length o f hospital stay, quicker return to normal activities and improved cosmesis.32 Most o f these benefits still await well-designed prospective, randomized clinical studies. Despite the lack o f data, VATS has been enthusiastically embraced by thoracic surgeons.22 Conceivably, any thoracic procedure performed by conventional thoracotomy can be completed through VATS.28 However, the surgeon’s enthusiasm must be tem pered by the relative cost effectiveness and therapeutic benefit o f VATS versus con ventional thoracotomy. With the paucity o f large clinical trials, VATS for pulmo nary tumors must be approached either through a protocol or strict oncologic guidelines. The paucity of clinical trials documenting the efficacy o f VATS is only surpassed by the lack of experimental data regarding the biology and pathophysi ology associated with this novel technique. This chapter describes several patho physiologic mechanisms associated with VATS.
