THORACOSCOPIC MANAGEMENT OF PULMONARY NODULES

More 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: One hundred and twenty-two nodules have been resected in 120 p atients. The average size of these nodules was 16 mm (3-30 mm). A pre- operative localization technique was used in 61 patients (50%). The pr ocedures were as follows : biopsy (6 cases), wedge-resection (110 case s). A video-assisted lobectomy was performed in 26 cases. Results: The mortality rate was 0.8% (one case of ARDS in the post-operative cours e of a video-assisted lobectomy). Intra-operative morbidity rate was 1 .6% (2 cases of haemorrhage requiring a thoracotomy) and the postopera tive morbidity rate was 5%. Six procedures were converted to thoracoto my (5%). The nodules were localized in all cases but 2 (1.6%). The mea n post-operative stay was 4.6 days in the whole series and 3.2 days in the series of patients with a simple biopsy or wedge-resection. Comme nts The morbidity rate of thoracoscopic resection of lung nodules is v ery low and decreases with the experience of the surgeon. Experience a llows one not to use a localization technique in many cases, but the t atter remains helpful in small-sized nodules. It allows for a safe, ra pid and accurate procedure to be performed. The need for a mini-thorac otomy is very rare. Mastering the techniques of radiological localizat ion techniques, thoracoscopic biopsy and wedge resection as well as vi deo-assisted lobectomies should make it possible for thoracoscopic res ection of lung nodules to fulfil the criteria of a minimally invasive operation.