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The Annals of Thoracic Surgery, Vol 54, 415-419, Copyright © 1992 by The Society of Thoracic Surgeons
RJ Landreneau, SR Hazelrigg, PF Ferson, JA Johnson, W Nawarawong, TM Boley, JJ Curtis, CM Bowers, DB Herlan and RD Dowling
Advances in endoscopic surgical equipment and laser technology have
expanded the role of thoracoscopy to include thoracoscopic pulmonary
resection. Eighty-five thoracoscopic pulmonary resections were performed on
61 consecutive patients with small lesions (less than 3 cm) in the outer
third of the lung. Patients with preoperative histologic evidence of
bronchogenic carcinoma were excluded unless there was impairment of
cardiopulmonary function, advanced age, or concomitant extrathoracic
malignancy. These thoracoscopic pulmonary resections were accomplished with
the neodymium:yttrium-aluminum garnet laser (31), endoscopic stapler (29),
or both (25). The mean diameter of the lesions was 1.3 cm (range, 0.4 to
2.7 cm). There has been one late death (38th postoperative day) unrelated
to the operation. Morbidity consisted of postoperative atelectasis (2),
pneumonia (2), bleeding requiring transfusion (1), and bronchopleural
fistula of greater than 7 days duration (3). There were no wound problems.
The mean period of chest tube drainage was 3.3 +/- 3.0 days. Mean
postoperative stay was 5.7 +/- 4.9 days. The pathologic diagnosis was
benign disease in 28 patients (interstitial fibrosis/pneumonitis, 15;
radiation fibrosis, 1; sclerosing hemangioma, 1; rheumatoid nodules, 1;
granuloma, 2; nocardia, 1; infarct, 1; hamartoma, 4; scar, 1;
cytomegalovirus pneumonia, 1), metastatic malignancy in 20 patients, and
bronchogenic carcinoma in 13 patients. Five patients found at thoracoscopic
pulmonary resection to have bronchogenic cancer had adequate pulmonary
function and therefore underwent formal segmentectomy (3) or lobectomy (2).
Thoracoscopic pulmonary resection was the only operation performed on
patients with benign disease, patients with metastatic lesions, and
selected patients with limited stage bronchogenic carcinoma at increased
risk for thoracotomy.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Thoracoscopic resection of 85 pulmonary lesions
Section of Thoracic Surgery, University of Pittsburgh, Pennsylvania 15213.
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