title: Laser application enables awake thoracoscopic resection of pulmonary nodules with minimal access.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Thoracic and Vascular Surgery, SRH Wald-Klinikum Gera, Teaching Hospital of Friedrich-Schiller-University of Jena, Strasse des Friedens 122, 07548, Gera, Germany. thomas.lesser@wkg.srh.de
authors: Thomas G
authors: TG
authors: Lesser
mesh_terms: D000368:Aged; D000772:Anesthesia, Local; D016022:Case-Control Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000601:surgery*; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D014851:Wakefulness