Thoracoscopic management of pulmonary nodules

Abstract

SummaryMore and more pulmonary nodules are currently approached via thoracoscopy. We have evaluated the results and the morbidity of a consecutive series of 120 patients operated on by a single surgeon. Patients and methods. One hundred and twenty-two nodules have been resected in 120 patients. The average size of these nodules was 16 mm (3–30 mm). A pre-operative localization technique was used in 61 patients (50%). The procedures were as follows: biopsy (6 cases), wedge-resection (110 cases). A video-assisted lobectomy was performed in 26 cases. Results. The mortality rate was 0.8% (one case of ARDS in the post-operative course of a video-assisted lobectomy). Intra-operative morbidity rate was 1.6% (2 cases of haemorrhage requiring a thoracotomy) and the postoperative morbidity rate was 5%. Six procedures were converted to thoracotomy (5%). The nodules were localized in all cases but 2 (1.6%). The mean post-operative stay was 4.6 days in the whole series and 3.2 days in the series of patients with a simple biopsy or wedge-resection. Comments. The morbidity rate of thoracoscopic resection of lung nodules is very low and decreases with the experience of the surgeon. Experience allows one not to use a localization technique in many cases, but the latter remains helpful in small-sized nodules. It allows for a safe, rapid and accurate procedure to be performed. The need for a mini-thoracot-omy is very rare. Mastering the techniques of radiological localization techniques, thoracoscopic biopsy and wedge resection as well as video-assisted lobectomies should make it possible for thoracoscopic resection of lung nodules to fulfil the criteria of a minimally invasive operation.