Most cardiothoracic surgeons (80%) do not believe thoractomy is required for an optimal operation - a contrasting viewpoint from that reflected in existing guidelines from the British Thoracic Society. Recent evidence suggests that the time might be right for a revision of the 2003 BTS guidelines on this specific point.

The BTS guidelines refer to thoractomy and surgical pleurectomy as the "gold standard" and state that VATS must be evaluated against this standard. But a report in this month's edition of the Journal of the Royal Society of Medicine states that, in the 15 years since the introduction of video assisted thoracic surgery (VATS - sometimes called "keyhole and camera" surgery), practice has changed towards this much less invasive procedure and away from thoracotomy.

The review, by Professor Tom Treasure, Professor of Cardiothoracic Surgery at Guy's Hospital, London, looked at existing evidence from randomized trials, non-randomized comparative studies and also sought the views of surgeons in a formal opinion-gathering exercise. Professor Treasure concluded that, "Unless there are specific clinical indications for more invasive surgery, it would seem reasonable for VATS to become the recommended approach."

In Professor Treasure's opinion survey, conducted at the Royal Society of Medicine during a meeting of the Society's Cardiothoracic Section, the majority of those questioned - (87%) - believed the operation to be more easily done by VATS (Video Assisted Thoracic Surgery) developed from laparascopic surgery.

If their own family member were to have an elective operation, 79% would prefer VATS to be used; however, in a non-elective situation, 44% believed the choice should be left up to the surgeon.

Minimally invasive surgery for pneumothorax: the evidence, changing practice and current opinion [PDF 76k]

'Minimally invasive surgery for pneumothorax: the evidence, changing practice and current opinion' is published in the September issue (Vol.100) of the Journal of the Royal Society of Medicine.

Professor Treasure is available for comment.

JRSM is the flagship journal of the Royal Society of Medicine. It has been published continuously since 1809. Its Editor is Dr Kamran Abbasi.

The article is available free at