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VATS wedge resection

From Surgopaedia

Principles

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  • Aim for a 15mm margin
  • Segmentectomy preferred to non-anatomical wedge resection

Indications for wedge resection alone

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  • Patient factors
    • Poor cardiopulmonary reserve
    • Preference
  • Anatomical factors
    • Peripheral
    • <2cm (non-inferior to lobectomy in T1aN0 NSCLC)
    • Multiple GGOs
    • No pleural invasion
  • Tumour factors
    • Low PET avidity
    • Lower grade

Localisation of lesions

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  • Harder with nodules <5mm, >2cm from pleural surface, small ground glass opacities
  • CT-guided localisation needle (can migrate or dislodge during lung isolation)
  • Navigational bronchoscopy
  • Intra-operative ultrasound
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