Resection of pulmonary nodules using video-assisted thoracic surgery

Background. The aim of this study was to assess the experience with video-assisted thoracic surgery for the resection of pulmonary nodules. Methods. This voluntary registry (20 centers) included 388 patients with either benign (n = 171) or malignant (n = 217) pulmonary nodules. Pulmonary nodules were located using computed tomography scan-guided injection of methylene blue (59 patients) and hook wire technique (17 patients). Results. Video-assisted thoracic surgery was converted into thoracotomy in 67 patients (17%) because of technical emergency in 4, inability to complete resection in 33, and the need to perform lobectomy for cancer through thoracotomy in 30. In other patients, video-assisted thoracic surgery allowed wedge resection in 300 cases and lobectomy in 21 cases. No intraoperative and two postoperative deaths (0.56%) occurred. The complication rate was 8% (n = 31). Mean durations of chest tube placement and hospital stay were 3.3 days (range, 1 to 20 days) and 6 days (range, 1 to 25 days), respectively. Video-assisted thoracic surgery was judged by the surgeon to be a diagnostic procedure 226 times (58%) and a therapeutic procedure 162 times (42%). Conclusion. Video-assisted thoracic surgery appears to be safe and remains mainly a diagnostic procedure for malignant tumors.