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BACKGROUND -
Presently there is significant variation in the nomenclature used to describe thoracic operation done by minimal access. Commonly used terms are: “Video Assisted Surgery” (VATS), “Minimally Invasive Thoracic Surgery” (MITS) and “minimal Access thoracic Surgery” (MATS).
VATS is further categorised by some as c-VATS (Complete VATS) and a-VATS (assisted VATS). Its operative technique also varies from being completely endoscopic to having an access thoracotomy, Utility Port, Working Port or Utility Thoracotomy of anywhere from 4-10 Cm.
Such variation obviously raises the question as to where does mini-thoracotomy join in or deviate from the larger of these “access/working” incisions’ of VATS? And which incision should be crowned as standard “Thoracotomy?
There is a need to clearly define the boundaries and criteria which would set these procedures apart.
METHODS -
The author suggests a simple system of streamlining these terminologies, in an adult patient of average built, based upon the following four criteria:
1, length of the incision
2, use of spreader
3, use of VATS or non-VATS Instruments &
4, the intra-cavity use of surgeons’ hand/s.
The issue of chest wall muscle cutting is not taken into definition as an Utility port or a mini-thoracotomy can be made by division as well as separation of muscle fibres.
A hybrid term of “Thoracoto-scopy” (Thoracotomy + Thoracoscopy) is suggested to make the definitions smoothly graduated.
A visual depiction of the proposed nomenclature is presented in table 1.
Table 1
Allowed Not Allowed
RESULTS -
Our clinical experience with 100 non-oncological procedures is presented. It is feasible and easy to categorise minimal access operations with this method.
CONCLUSIONS -
The question of nomenclature is more than a matter of semantics. It is necessary to streamline these differences, clarifying the exact technique used, so as to make meaningful comparison of results from different surgeons. Our suggested system of classification could fill in that need.