History of an abdominal GIST tumor s/p resection a few years ago. As part of her monitoring she was found to have a right lower lobe nodule. I saw the patient in the office and offered her surgery. The plan was to remove the nodule through a VATS approach. If it represented a new lung cancer, I would proceed with a completion lobectomy. Risks and benefits of the procedure were explained to the patient preoperatively. She understood the risks and agreed to proceed.
1. Right video assisted thoracoscopy
2. Right lower lobe wedge resection (via VATS) of lung nodule
3. Placement of left radial aline
The patient was brought to the operating room and his identity was confirmed using two methods. The procedure was also confirmed. The patient was placed in the supine position on the OR table. After the induction of general anesthesia, a left aline was placed by the first assistant. The patient was placed in the lateral decubitus position with the right side up. Three small incisions were made to access the mass. The first incision was made below the tip of the scapula, the second incision was made in the anterior axillary line in the 5th intercostal space and the third incision was made midway between these two incisions. Using the videoscope and a grasper, the inferior pulmonary ligament was first divided to help mobilize the lung. Next two graspers were used to palpate the lung. Eventually a hard lesion was found in the periphery of the lower lobe. This was held with one of the graspers, while a stapler was placed through the other incision. One firing of the 45 stapler was used to remove this lesion via a wedge resection. This was sent to pathology, where frozen section showed no malignancy. The pleural space was irrigated out with saline. All bleeding was controlled. A 28F chest tube was placed through one of the incisions to the apex. The other two incisions were closed in layers. The patient tolerated the procedure without difficulty.