VATS (VIDEO-ASSISTED THORACIC-SURGERY) OF UNDEFINED PULMONARY NODULES- PREOPERATIVE EVALUATION OF VIDEOENDOSCOPIC RESECTABILITY

Peripheral undefined pulmonary nodules have become a favorable indicat ion for the videoendoscopic approach in thoracic surgery. In our lates t experience, we also successfully applied this technique in centrally located lesions of the lung. In reviewing our first 29 cases, we look ed for preoperative features of videoendoscopic resectability. From Ma rch 1992 to September 1993, 29 patients underwent videothoracoscopy fo r undefined pulmonary nodules at our hospital. This group consisted of 17 men and 12 women (aged 25 to 77 years). Pulmonary nodules of this group of patients were defined as centrally located when close attache ment to the segmental or subsegmental bronchiopulmonary unit was obser ved and/or the distance to the visceral pleura exceeded 10 mm. Nodules that did not meet any of these criteria were hence interpreted as per ipheral lesions. In the course of 21 excisions of peripheral lesions, we had to convert to open thoracotomy only once for anatomic reasons. When using the video-assisted thoracic surgery (VATS) approach for cen trally located lesions, we succeeded in removing four of six. We faile d only if the lesions were located in the upper lobe but could easily apply the technique for centrally located lesions in the lower lobes. In conclusion, undefined peripheral pulmonary nodules are a favorite i ndications for VATS. Centrally located pulmonary nodules of the lower lobes can often be managed easily by VATS, especially if the interloba r fissure extends to the stem of the pulmonary artery. Centrally locat ed pulmonary nodules in the upper lobes may not be suitable for the VA TS approach due to the special anatomic arrangement of the upper lobe segmental arteries and bronchioles.