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- Title
The use of diagnostic complex robotic-assisted segmentectomy in the management of incidental and screen-detected pulmonary nodules.
- Authors
Lee, Michelle; Santhirakumaran, Gowthanan; Waller, David; Elkhouly, Ahmed; Dhanji, Al-Rehan; Wilson, Henrietta; Stamenkovic, Steven
- Abstract
OBJECTIVES Robotic-assisted thoracoscopic surgery (RATS) facilitates complex pulmonary segmentectomy which offers one-stage diagnostic and therapeutic management of small pulmonary nodules. We aimed to explore the potential advantages of a faster, simplified pathway and earlier diagnosis against the disadvantages of unnecessary morbidity in benign cases. METHODS In an observational study, patients with small, solitary pulmonary nodules deemed suspicious of malignancy by a multidisciplinary team were offered surgery without a pre or intraoperative biopsy. We report our initial experience with RATS complex segmentectomy (using >1 parenchymal staple line) to preserve as much functioning lung tissue as possible. RESULTS Over a 4-year period, 245 RATS complex segmentectomies were performed; 140 right: 105 left. A median of 2 (1–4) segments was removed. There was no in-hospital mortality and no requirement for postoperative ventilation. Complications were reported in 63 (25.7%) cases, of which 36 (57.1%) were hospital-acquired pneumonia. A malignant diagnosis was found in 198 (81%) patients and a benign diagnosis in 47 (19%). The malignant diagnoses included: adenocarcinoma in 136, squamous carcinoma in 31 and carcinoid tumour in 15. The most frequent benign diagnosis was granulomatous inflammation in 18 cases. CONCLUSIONS RATS complex segmentectomy offers a precise, safe and effective one-stop therapeutic biopsy in incidental and screen-detected pulmonary nodules.
- Subjects
PULMONARY nodules; SOLITARY pulmonary nodule; CHEST endoscopic surgery; NEEDLE biopsy; HOSPITAL mortality
- Publication
European Journal of Cardio-Thoracic Surgery, 2024, Vol 65, Issue 5, p1
- ISSN
1010-7940
- Publication type
Article
- DOI
10.1093/ejcts/ezae139