Surgical Endoscopy

, Volume 26, Issue 4, pp 1181–1186 | Cite as

Laser application enables awake thoracoscopic resection of pulmonary nodules with minimal access

New Technology



Thoracoscopic resection of indeterminate pulmonary nodules is most commonly performed through three trocars using an endoscopic stapler. We assessed the safety, feasibility, and results of laser resection via minimal access under only local anesthesia.


Between September 2009 and June 2010, excision of subpleural nodules using laser application under only local anesthesia was performed in 28 patients (Laser group). A 2-mm trocar (minigrasper) and an 11-mm trocar (operating scope) were used. Anesthesia time, surgery time, global operating room time, chest tube time, piritramid dose, and hospital stay were assessed and compared with data from a patient group (n = 28) that required nodule resection through three trocars using an endoscopic stapler under general anesthesia (Control group).


There was no mortality or major morbidity. There was no difference in technical feasibility between the groups. Two patients in the Laser group and one patient in the Control group required conversion to thoracotomy due to severe adhesions. The mean nodule size was 0.9 ± 0.2 cm in the Laser group and 1.0 ± 0.3 cm in the Control group (P = 0.05). Comparisons of Laser group results with Control group results showed that in the Laser group, anesthesia time (3 ± 0.7 vs. 42 ± 6.3 min, P < 0.001), global operating room time (51 ± 4.8 vs. 88 ± 10.8 min, P < 0.001), piritramid dose (65.9 ± 30.5 vs. 109.1 ± 21.9 mg, P < 0.001), and hospital stay (2.3 ± 0.9 vs. 3.2 ± 0.6 days, P < 0.001) were significantly reduced. Patients’ satisfaction was high. Ninety-eight percent of patients said they would undergo this surgery again.


Awake thoracoscopic laser resection of subpleural pulmonary nodules proved safe and feasible. This technique may enable further reduction of invasiveness, length of hospital stay, and costs in selected patients.


Pulmonary nodule Laser Awake thoracoscopy/VAT 


  1. 1.
    Hazelrigg SR, Magee MJ, Cetindag IB (1998) Video-assisted thoracic surgery for diagnosis of the solitary lung nodule. Chest Surg Clin North Am 8:763–764Google Scholar
  2. 2.
    Allen MS, Deschamps C, Lee RE, Trastek VF, Daly RC, Pairolero PC (1993) Video-assisted thoracoscopic stapled wedge excision for indeterminate pulmonary nodules. J Thorac Cardiovasc Surg 106:1048–1052PubMedGoogle Scholar
  3. 3.
    Murasugi M, Onuki T, Ikeda T, Kanzaki M, Nitta S (2001) The role of video-assisted thoracoscopic surgery in the diagnosis of the small peripheral pulmonary nodule. Surg Endosc 15:734–736PubMedCrossRefGoogle Scholar
  4. 4.
    Pompeo E, Mineo D, Rogliani P, Sabato AF, Mineo TC (2004) Feasibility and results of awake thoracoscopic resection of solitary pulmonary nodules. Ann Thorac Surg 78:1761–1768PubMedCrossRefGoogle Scholar
  5. 5.
    Katlic MR, Facktor MA (2010) Video-assisted thoracic surgery utilizing local anesthesia and sedation: 384 consecutive cases. Ann Thorac Surg 90:240–245PubMedCrossRefGoogle Scholar
  6. 6.
    Pannier F, Rabe E, Maurins U (2010) 1470 nm diode laser for endovenous ablation (EVLA) of incompetent saphenous veins—a prospective randomized pilot study comparing warm and cold tumescence anaesthesia. VASA 39:249–255PubMedGoogle Scholar
  7. 7.
    Rolle A, Pereszlenyi A, Koch R, Richard M, Baier B (2006) Is surgery for multiple lung metastases reasonable? A total of 328 consecutive patients with multiple-laser metastasectomies with a new 1318-nm Nd:YAG laser. J Thorac Cardiovasc Surg 131:1236–1242PubMedCrossRefGoogle Scholar
  8. 8.
    Mack MJ, Hazelrigg SR, Landreneau RJ, Acuff TE (1993) Thoracoscopy for the diagnosis of the indeterminate solitary pulmonary nodule. Ann Thorac Surg 56:825–830PubMedCrossRefGoogle Scholar
  9. 9.
    Pompeo E, Tacconi F, Mineo D, Mineo TC (2007) The role of awake video-assisted thoracoscopic surgery in spontaneous pneumothorax. J Thorac Cardiovasc Surg 133:786–790PubMedCrossRefGoogle Scholar
  10. 10.
    Pompeo E, Mineo TC (2008) Awake operative videothoracoscopic pulmonary resections. Thorac Surg Clin 18:311–320PubMedCrossRefGoogle Scholar
  11. 11.
    Jutley RS, Khalil MW, Rocco G (2005) Uniportal vs standard three-port VATS technique for spontaneous pneumothorax: comparison of post-operative pain and residual paraesthesia. Eur J Cardiothorac Surg 28:43–46PubMedCrossRefGoogle Scholar
  12. 12.
    Dowling RD, Landreneau RJ, Wachs ME, Ferson PF (1992) Thoracoscopic Nd:YAG laser resection of a solitary pulmonary nodule. Chest 102:1903–1905PubMedCrossRefGoogle Scholar
  13. 13.
    Keenan RJ, Ferson PF, Landreneau RJ, Hazelrigg SR (1993) Use of lasers in thoracoscopy. Semin Thorac Cardiovasc Surg 5:294–297PubMedGoogle Scholar
  14. 14.
    Mineo TC, Cristino B, Ambrogi V, Natali GL, Casciani CU (1994) Usefulness of the Nd:YAG laser in parenchyma-sparing resection of pulmonary nodular lesions. Tumori 80:365–369PubMedGoogle Scholar
  15. 15.
    Venuta F, Rolle A, Anile M, Martucci N, Bis B, Rocco G (2010) Techniques used in lung metastasectomy. J Thorac Oncol 5:145–150CrossRefGoogle Scholar
  16. 16.
    Takarada T, Kawahara M, Irifune M, Endo C, Shimizu Y, Kobayashi K, Sakata K, Kikuchi N, Saida T, Onizuka C (2007) An alternative approach to the monitoring of respiration by dynamic air-pressure sensor. Anesth Prog 54:2–6PubMedCrossRefGoogle Scholar
  17. 17.
    Han IS, Chung EY, Hahn YJ (2010) Spinal epidural hematoma after epidural anesthesia in a patient receiving enoxaparin—a case report. Korean J Anesthesiol 59:119–122PubMedCrossRefGoogle Scholar
  18. 18.
    Miyazaki M, Takasita M, Matsumoto H, Sonoda H, Tsumura H, Torisu T (2005) Spinal epidural hematoma after removal of an epidural catheter: case report and review of the literature. J Spinal Disord Tech 18:547–551PubMedCrossRefGoogle Scholar
  19. 19.
    Choe WJ, Choe JH, Kim JW (2006) Epidural hematoma after epidural catheterization without coagulopathy: a case report. Korean J Anesthesiol 50:221–223Google Scholar
  20. 20.
    Kovács O, Szántó Z, Krasznai G, Herr G (2009) Comparing bipolar electrothermal device and endostapler in endoscopic lung wedge resection. Interact Cardiovasc Thorac Surg 9:11–14PubMedCrossRefGoogle Scholar
  21. 21.
    Downey DM, Harre JG, Pratt JW (2006) Functional comparison of staple line reinforcements in lung resection. Ann Thorac Surg 82:1880–1883PubMedCrossRefGoogle Scholar
  22. 22.
    Rocco G, Romano V, Accardo R, Tempesta A, La Manna C, La Rocca A, Martucci N, D’Aiuto M, Polimeno E (2010) Awake single-access (uniportal) video-assisted thoracoscopic surgery for peripheral pulmonary nodules in a complete ambulatory setting. Ann Thorac Surg 89:1625–1627PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Thoracic and Vascular SurgerySRH Wald-Klinikum Gera, Teaching Hospital of Friedrich-Schiller-University of JenaGeraGermany

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