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The Journal of Thoracic and Cardiovascular Surgery, Vol 106, 1048-1052, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
MS Allen, C Deschamps, RE Lee, VF Trastek, RC Daly and PC Pairolero
Between June 1991 and July 1992, 118 patients (57 men and 61 women)
underwent video-assisted thoracoscopy for indeterminate pulmonary nodules.
Median age was 64 years (range 30 to 85 years). Thoracotomy was performed
in 33 patients (28.0%) after thoracoscopy only because the nodule could not
be located in 17 patients, was too large to safely resect in 5, appeared
malignant in 4, and for technical reasons in 7. Eighty-five patients
underwent thoracoscopic wedge excision. Twenty-one (24.7%) of these 85
patients also had thoracotomy--15 to perform formal lung resection for
bronchogenic carcinoma, 3 for nondiagnostic abnormalities, 2 to locate a
second nodule, and 1 for stapler malfunction. The remaining 64 patients
(54.2%) had only video-assisted thoracoscopic wedge excision. A single
wedge excision was performed in 56 patients, two in 6, and three in 2.
Pathologic examination of these 74 nodules revealed a granuloma in 30,
metastatic cancer in 25, hamartoma in 7, lymphoma in 1, and other benign
lesions in 11. There were no deaths and only 4 (6.3%) complications in
these 64 patients. The 64 patients treated by thoracoscopy only were
compared with a similar group of 64 patients who had wedge excision via
thoracotomy without prior thoracoscopy. Postoperative analgesic
requirements were less in the patients treated by thoracoscopy. Median
hospitalization in the thoracoscopy group was 3 days compared with 6 days
in the thoracotomy group (p < 0.05). Median total charge for the
thoracoscopy- only group was $12,898 as compared with $12,502 for patients
undergoing wedge excision via thoracotomy. We conclude that thoracoscopic
wedge excision is a safe and effective procedure in selected patients with
an indeterminate pulmonary nodule. A significant number of patients
(45.8%), however, required a thoracotomy to accomplish a safe operation or
to ensure adequate staging and resection for malignancy. Although
thoracoscopy reduces postoperative analgesia requirements and shortens
hospital stay, total hospital charges were similar to charges for a wedge
excision via thoracotomy.
ARTICLES
Video-assisted thoracoscopic stapled wedge excision for indeterminate pulmonary nodules
Section of General Thoracic Surgery, Mayo Clinic, Rochester, Minn 55905.
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