VIDEO-ASSISTED THORACOSCOPIC STAPLED WEDGE EXCISION FOR INDETERMINATEPULMONARY NODULES

Between June 1991 and July 1992, 118 patients (57 men and 61 women) un derwent video-assisted thoracoscopy for indeterminate pulmonary nodule s. Median age was 64 years (range. 30 to 85 years). noracotomy was per formed in 33 patients (28.0%) after thoracoscopy only because the nodu le 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 lun g resection for bronchogenic carcinoma, 3 for nondiagnostic abnormalit ies, 2 to locate a second nodule, and 1 for stapler malfunction. Tle r emaining 64 patients (54.2%) had only video-assisted thoracoscopic wed ge excision. A single wedge excision was performed in 56 patients, two in 6, and three in 2. Pathologic examination of these 74 nodules reve aled a granuloma in 30, metastatic cancer in 25, hamartoma in 7, lymph oma in 1, and other benign lesions in 11. There were no deaths and onl y 4 (6.3%) complications in these 64 patients. The 64 patients treated by thoracoscopy only were compared with a similar group of 64 patient s who had wedge excision via thoracotomy without prior thoracoscopy. P ostoperative 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). Media n 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 thoraco tomy 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 char ges were similar to charges for a wedge excision via thoracotomy.