Video-assisted thoracoscopic stapled wedge excision for indeterminate pulmonary nodules

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Surgical Oncology

Background:

• Indeterminate pulmonary nodules require accurate diagnosis and treatment.
• Video-assisted thoracoscopy (VATS) offers a minimally invasive approach for thoracic procedures.
• The role of VATS in managing pulmonary nodules needs evaluation.

Purpose of the Study:

• To evaluate the safety and efficacy of video-assisted thoracoscopic wedge excision for indeterminate pulmonary nodules.
• To compare outcomes of VATS wedge excision with traditional thoracotomy.

Main Methods:

• A retrospective review of 118 patients undergoing VATS for indeterminate pulmonary nodules between June 1991 and July 1992.
• Analysis of conversion rates to thoracotomy, pathological findings, complications, and postoperative outcomes.
• Comparison of VATS-only group with a matched thoracotomy-only group.

Main Results:

• 64 patients (54.2%) were treated with VATS wedge excision only; 33 (28.0%) required conversion to thoracotomy.
• Pathology revealed granulomas (30), metastatic cancer (25), and hamartomas (7), among others.
• The VATS-only group had fewer analgesic requirements and shorter hospital stays (3 vs. 6 days) but similar total charges compared to thoracotomy.

Conclusions:

• Video-assisted thoracoscopic wedge excision is a safe and effective option for selected patients with indeterminate pulmonary nodules.
• A significant proportion of patients require thoracotomy for complete resection or staging.
• VATS demonstrates benefits in reduced postoperative pain and shorter hospitalization, despite comparable overall costs.