THORACOSCOPIC APPROACH OF PULMONARY NODULES - PROSPECTIVE EVALUATION OF 120 PATIENTS

Mole and more pulmonary nodules are currently approached via thoracosc opy. We have evaluated the results and the morbidity of a consecutive series of 120 patients operated on by a single surgeon. Patients and M ethods : Hundred twenty-two nodules have been approached thoracoscopic ally in 120 patients. The average size of these nodules was 16 mm (3-3 0 mm). A pre-operative localisation technique has been used in 61 pati ents (50%). The procedures were as follows: biopsy (6 cases), wedge-re section (110 cases). A video-assisted lobectomy has been performed in 26 cases. Results: The mortality rate was 0.08% (One case of ARDS in t he post-operative course of a video-assisted lobectomy). Intra operati ve morbidity rate was 1.6% (2 cases of haemorrhage requiring a thoraco tomy and the post-operative morbidity rate was 5%. Six procedures were converted to thoracotomy 55%). The nodules have been localised 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 biop sy or wedge-resection. Comment: The morbidity rate of thoracoscopic re section of lung nodules is very low and decreases with surgeon's exper ience. Experience allows one not to use a localisation technique in ma ny cases, but the later remains helpful in small size nodules. It allo ws for a safe, rapid and accurate procedure to be performed. The need far a mini-thoracotomy is very rare. Mastering the techniques of radio logical localisation techniques, thoracoscopic biopsy and wedge resect ion as wall as video-assisted lobectomies should make it possible for thoracoscopic resection of lung nodules to fulfil the criteria of a mi nimally invasive operation.