Nonintubated Needlescopic Video-Assisted Thoracic Surgery for Management of Peripheral Lung Nodules

Background. Video-assisted thoracic operations are usually performed with 5-mm or 10-mm instruments under general anesthesia with single-lung ventilation. Management of peripheral lung nodules by a needlescopic video-assisted thoracoscopic operation, without endotracheal intubation, has rarely been attempted. We evaluated the feasibility and safety of this minimally invasive technique in managing peripheral lung nodules. Methods. From August 2009 through March 2011, 46 patients with peripheral lung nodules were treated using 3-mm needlescopic video-assisted thoracoscopic operations for wedge resection with epidural anesthesia and sedation, without endotracheal intubation. Results. A definitive diagnosis was obtained in all 46. Extension of the 3-mm incisions was required in 8 patients because of primary lung cancer requiring a lobectomy in 3, pleural adhesions in 3, and difficulty in identifying or resecting the nodule in 2. Two patients required conversion to intubated single-lung ventilation because of dense adhesions between the lungs and the diaphragm. Operations lasted a mean of 69.2 +/- 46.8 minutes. Postoperative side effects occurred in 4 patients, including sore throat, headache, and vomiting requiring medication. Operative complications developed in 1 patient who had air leaks for more than 3 days postoperatively. The mean postoperative chest tube drainage and hospital stay were 1.1 days and 2.7 days, respectively. Postoperative neuralgia was noted in 12 patients (26%). Most patients (74%) were very satisfied or satisfied with the resulting scars. Conclusions. Nonintubated needlescopic video-assisted thoracoscopic operations are technically feasible and safe and may be a less invasive alternative in the management of selected patients with peripheral pulmonary nodules. (Ann Thorac Surg 2012;93:1049-54) (C) 2012 by The Society of Thoracic Surgeons