Applications of Video-assisted Thoracic Surgery for the Diagnosis and Treatment 
of Patients with Small Pulmonary Nodules

Abstract

Background and objective Chest computed tomography (CT), particularly thin-slice high resolution CT, has low sensitivity and specificity for detecting pulmonary nodules <10 mm in size. This limitation leads to challenges in clinical diagnosis and treatment of small pulmonary nodules. This study introduces the use of video-assisted thoracoscopic surgery (VATS) for the diagnosis and treatment of small pulmonary nodules. Methods From November 2009 to May 2012, 64 patients with small pulmonary nodules without prior preoperative pathologic diagnosis were treated by pulmonary wedge resection through VATS. The diagnosis of small pulmonary nodules was established from rapid frozen section. The type of operation depends on the pathology and the condition of the patients. Twenty patients with primary lung cancer were subjected to lobectomy and radical resection of the lymph nodes by complete thoracospic lobectomy or video-assisted thoracoscopic invasive lobectomy. Pulmonary wedge resection was performed in 44 patients, among whom 21 have benign nodule, 18 have precancerous lesion, 3 have metastatic nodule, and 2 have primary lung cancer for which lobectomy was not fit. Results Confirmative diagnosis is difficult to obtain among patients with small pulmonary nodules. VATS is effective in the diagnosis and treatment of small pulmonary nodules. With VATS, patients with benign small pulmonary nodules can be cured, and patients with primary lung cancer can receive definite diagnosis and effective treatment in time. Conclusion CT-guided hook-wire fixation is useful in precise lesion localization for surgical resection.

Keywords

• Video-assisted thoracoscopic surgery
• Small pulmonary nodules
• CT-guided hook-wire localization