Lung Biopsy

This is another fairly easy surgical maneuver to perform using video thoracoscopy. The trocar position depends on the location of the lesion. The lesion of the superior segment of the lower lobe is depicted in Figure 25.3. The grasper and staple gun can be positioned on opposite sides of the camera.

The thoracoscopic pulmonary mass resection is generally only applicable for lesions located in the periphery of the lung that can be visualized. It is very difficult to achieve the tactile sense thoracoscopically that is second nature for the surgeon in an open chest case. Nonetheless, there are techniques whereby lesions not visible on the visceral surface of the lung can be resected. One method which has been utilized at our hospital is to perform preoperative CT guided needle localization of such masses, injecting methylene blue at the same time. Using the needle localization/methylene blue technique, one is then able to identify the lesion quite readily using thoracoscopy and can staple resect the lesions. It is important to note that this procedure should never be used to perform a resection of lung cancer which may compromise the surgical outcome. In other words, if cancer is identified on wedge resection, then a formal pulmonary lobectomy should be performed. Formal lobectomy has been shown to decrease the recurrence of primary lung carcinoma, as compared to wedge resections or segmentectomies. Until prospective randomized studies document no survival disadvantage with wedge resection, the operation cannot be recommended.

Fig 25.3. Video thoracos-copy for resection of a lesion in the superior segment of the lower lobe. Reprinted with permission from Ann Thoracic Surg 1992; 54:800-807.
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