The role of video-assisted thoracic surgery in the diagnosis and treatment of indeterminate pulmonary lesion.

Patients with indeterminate pulmonary lesions usually require a definite diagnosis for proper management. The conventional diagnostic procedures such as bronchoscopy and transthoracic needle biopsy sometimes fail to obtain a decisive answer, thus a more aggressive diagnostic procedure will be needed. Video-assisted thoracic surgery (VATS) has provided an alternative for open thoracotomy for definite diagnosis in these conditions. Thirty-three patients with indeterminate pulmonary lesions received VATS in National Taiwan University Hospital. Of these patients, twenty-eight manifested with coin lesion and five had diffuse pulmonary infiltration before operation. Traditional diagnostic procedures, i.e. bronchoscopy or transthoracic needle biopsy, could not give a definite diagnosis for these patients. A definite diagnosis was obtained after thoracoscopy in all of these patients. The mean operation time was 129 minutes (range, 180 to 45 minutes). The mean duration of chest tube drainage was 4.1 days (range, 1 to 7 days). The mean postoperative hospital stay of elective surgery without subsequent chemotherapy or radiotherapy was 9.5 days (range, 5 to 14 days). The patients received 2.4 times parental narcotics injection for analgesia on average (range, 0 to 6 times). There is no operation-related death in this series. Three patients had prolonged air leak with seven days of chest tube drainage. Two patients, with CMV and chronic interstitial pneumonia, have mortality from their underlying disease later. VATS is a safe and effective procedure not only for diagnosis, but also for treatment in the management of indeterminate pulmonary lesions.