VATS (Video-Assisted Thoracic Surgery) of Undefined Pulmonary Nodules

Peripheral undefined pulmonary nodules have become a favorable indication for the videoendoscopic approach in thoracic surgery. In our latest experience, we also successfully applied this technique in centrally located lesions of the lung. In reviewing our first 29 cases, we looked for preoperative features of videoendoscopic resectability. From March 1992 to September 1993, 29 patients underwent videothoracoscopy for 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 attachement to the segmental or subsegmental bronchiopulmonary unit was observed and/or the distance to the visceral pleura exceeded 10 mm. Nodules that did not meet any of these criteria were hence interpreted as peripheral 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 centrally located lesions, we succeeded in removing four of six. We failed 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 indication for VATS. Centrally located pulmonary nodules of the lower lobes can often be managed easily by VATS, especially if the interlobar fissure extends to the stem of the pulmonary artery. Centrally located pulmonary nodules in the upper lobes may not be suitable for the VATS approach due to the special anatomic arrangement of the upper lobe segmental arteries and bronchioles.