Abstract
The approach to patients with indeterminate pulmonary nodules is poorly defined. Should every pulmonary nodule be biopsied, is needle biopsy adequate, and other questions are challenges. Video assisted thoracic surgery or thoracoscopy has added a new diagnostic possibility which is evaluated in this paper. Fifty-five patients underwent thoracoscopy for diagnosis of a solitary pulmonary nodule. There were few complications and mortality was zero. A definitive diagnosis was obtained in all patients, although one required a second thoracoscopic wedge resection and 10 required conversion to an open thoracotomy. As discussed in the paper, thoracoscopy provides the opportunity for safely establishing a definitive diagnosis in all patients with solitary nodules and the authors believe will become a standard part of the evaluation of these patients.
Highlights
The recent surge ofpopularity ofendoscopic or minimally invasive surgery has brought carcinoma of the lung, the most common visceral cancer in the United States, into the arena of thoracoscopy or video assisted thoracic surgery (VATS), but its role is not yet defined
The value of endoscopic or minimally invasive surgery is well documented for disease of the abdominal cavity
Conventional thoracoscopy has been used for evaluation of pleural disease for years (Weissburg and Kaufman)
Summary
The recent surge ofpopularity ofendoscopic or minimally invasive surgery has brought carcinoma of the lung, the most common visceral cancer in the United States, into the arena of thoracoscopy or video assisted thoracic surgery (VATS), but its role is not yet defined. A possible therapeutic role with performance of wedge resection as a definitive treatment of small lung tumors is not promising, as local recurrence and survival rates indicate that any resection less than lobar is inadequate for cure oflung cancer (Ginsburg, personal communication). Until anatomic resection such as lobectomy and pneumonectomy are established as standard thoracoscopic procedures, it appears that possible routine roles for thoracoscopy in the care of lung cancer patients are diagnosis and/or intrathoracic staging.
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