Ann Thorac Surg 2005;79:262
© 2005 The Society of Thoracic Surgeons
INVITED COMMENTARY
Joseph Miller, Jr, MD
Section of General Thoracic Surgery, The Emory Clinic, Inc, 1365 Clifton Rd, Building A, Atlanta, GA 30322
Sortini and colleagues have presented an informative and potential advancement in the localization of the solitary pulmonary nodules being considered for a thoracoscopic resection. My personal thoughts as a senior thoracic surgeon are that the authors are looking for a way to add an additional cost of technology to standardized ways that are already established in the detection and diagnosis of the solitary pulmonary nodule. In essence they are looking for a way to advance costly technology that does not need to be advanced.
They state that "...thoracoscopic localization of small and central nodules of the lung may be difficult...." This is known and understood by all seasoned thoracic surgeons. In fact, most surgeons generally agree that these deep, centrally located lesions should be approached by a limited open technique. On the other hand, peripheral 2-cm lesions can be localized through computed tomography (CT) and finger palpitation more than 80% of the time. A senior surgeon who combines CT imagery, adequate knowledge of thoracoscopy, a 2-inch skin incision with scope, and finger palpitation through the same incision (with no retractor), can excise more than 90% of all 1-cm to 2-cm peripheral lung lesions.
Most centers have moved away from wire localization and methylene blue injections for the reasons the authors have stated. My personal feelings now are similar to what was felt in the early 1990s about thoracoscopy: the authors are looking for a new way to add an evolving technology that is expensive, time consuming, and not necessary to be evaluated and considered. I have 30 years of experience as a senior thoracic surgeon and I believe that thoracoscopy is a wonderful procedure—when used for the correct reasons. More than 90% of all 1-cm to 2-cm peripheral lesions located within 2 cm of the periphery of the lung can be excised with standard thoracoscopic techniques. Deep-seated lesions in the lung should be approached openly, not thoracoscopically. The authors are to be congratulated in their evaluation of a new technology, but I find it gives no additional advantage to an experienced surgeon.
Related Article
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Thoracoscopic Localization Techniques for Patients With Solitary Pulmonary Nodule and History of Malignancy
- Davide Sortini, Carlo V. Feo, Paolo Carcoforo, Giovanni Carrella, Enzo Pozza, Alberto Liboni, and Andrea Sortini
Ann. Thorac. Surg. 2005 79: 258-262.
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