The impact of thoracic surgical access on early shoulder function: video-assisted thoracic surgery versus posterolateral thoracotomy

Objective: Whether video-assisted thoracic surgery (VATS) is associated with less shoulder dysfunction when compared with posterolateral thoracotomy (PLT) remains unclear. We therefore conducted this prospective study to assess the shoulder function in patients following major lung resection using e...

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Bibliographic Details
Published in:	European journal of cardio-thoracic surgery Vol. 23; no. 3; pp. 390 - 396
Main Authors:	Li, Wilson W.L., Lee, Rosanna L.M., Lee, T.W., Ng, Calvin S.H., Sihoe, Alan D.L., Wan, Innes Y.P., Arifi, Ahmed A., Yim, Anthony P.C.
Format:	Journal Article Conference Proceeding
Language:	English
Published:	Amsterdam Elsevier Science B.V 01-03-2003 Elsevier Science
Subjects:	Activities of Daily Living Adult Aged Analgesics - administration & dosage Biological and medical sciences Drug Administration Schedule Female Follow-Up Studies Humans Male Medical sciences Middle Aged Pain, Postoperative - etiology Postoperative Period Prospective Studies Range of Motion, Articular Shoulder function Shoulder Joint - physiopathology Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the respiratory system Thoracic Surgery, Video-Assisted - adverse effects Thoracic Surgery, Video-Assisted - rehabilitation Thoracotomy Thoracotomy - adverse effects Thoracotomy - rehabilitation Video-assisted thoracic surgery Shoulder function Thoracotomy Video-assisted thoracic surgery Human Lung Diseases of the osteoarticular system Video technique Exploration Surgical resection Guidance Pain Functional recovery Surgery Shoulder Complication Surgical approach Technique Comparative study
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Summary:	Objective: Whether video-assisted thoracic surgery (VATS) is associated with less shoulder dysfunction when compared with posterolateral thoracotomy (PLT) remains unclear. We therefore conducted this prospective study to assess the shoulder function in patients following major lung resection using either the VATS or PLT approach. Methods: Twenty-nine consecutive patients were prospectively recruited into the study. Eighteen patients underwent major lung resection through VATS (VATS group) and 11 patients through PLT (open group). Shoulder function was measured preoperatively, and postoperatively at 1 week, 1 month and at 3 months. All assessments were done by two experienced physiotherapists using the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. Results: Shoulder strength was significantly better preserved in the VATS group at 1 week after surgery when compared with the PLT group (92 versus 81% of preoperative value; P=0.024). VATS patients also had better range of motion especially with respect to external rotation at 1 week (98 versus 91%; P=0.015) and forward elevation at 1 month (98 versus 93%; P=0.024) and 3 months after surgery (100 versus 96%; P=0.021). Analgesic requirement was significantly less in the VATS group postoperatively at 1 week (P=0.009) and 1 month (P=0.004). Conclusions: VATS major lung resection is associated with significantly less shoulder dysfunction and pain medication requirement in the early postoperative period when compared to the PLT approach.
Bibliography:	ark:/67375/HXZ-9GDWGW4S-1 istex:4EC0225D4D95078FB06E39E166DEA109BD557988 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1010-7940 1873-734X
DOI:	10.1016/s1010-7940(02)00795-9