To examine the early experience of entirely thoracoscopic lobectomy in treatment of lung nodules at a 780 bed academic medical center.
Prospective data were collected on twenty patients who underwent successful thoracoscopic lobectomy from September 2002 to April 2003 after flexible bronchoscopy and staging mediastinoscopy. The study population consisted of 6 men and 14 women with a mean age of 61 years. A thoracic surgery nurse practitioner performed daily data collection and tracked operative and post-operative complications.
Length of stay (LOS) analysis showed a median of 4 days and a mean of 7.3 ± 5.8 days. LOS was ≤ 4 days in 55% of study participants. One death occurred in the post-operative period secondary to mesenteric ischemia. Eighteen complications occurred in nine of the twenty patients. Two patients suffered major complications (mesenteric ischemia, colonic volvulus, empyema, and atrial fibrillation). Four patients had prolonged air leaks and two of these patients had clinical subcutaneous emphysema. Eighteen patients were discharged in good condition. Malignant tumors were found in 80% of cases. Tumor size was ≤ 3 cm in 80% of patients. Non-malignant findings included: focal pulmonary vascular congestion, lymphoid infiltrate (2), and emphysema with focal fibrosis.CONCLUSIONS: The mortality of this patient population was 5%, and some type of complication occurred in 45% of patients. In patients with cancer, 69% had stage 1a and 31% had stage 1b disease.
Thoracoscopic lobectomy is a minimally invasive technique that is gradually gaining acceptance in the thoracic surgery community. Our early experience with this technique demonstrates a favorable length of hospital stay compared to the open approach. Complications encountered are similar to those encountered during minimally invasive pulmonary wedge and segmental resections. We believe that increased surgical volume will result in a lower mean LOS, mortality, and complications.
F.J. Podbielski, None.