The term Solitary Pulmonary Nodule (SPN) refers to a newly developed lung nodular lesion
of unknown origin and up to 3 cm in diameter, which is completely surrounded by normal parenchyma
without atelectasis or adenopathy.
Video-Assisted Thoracic Surgery (VATS) has been increasingly advocated as an ideal approach for
management of peripheral SPN due the satisfactory results and negligible morbidity rates reported with
this minimal invasive surgical option. General anesthesia with one-lung ventilation has been considered
mandatory to accomplish a safe operation by VATS. However, this type of anesthesia should not be
considered strictly necessary to accomplish simple pulmonary resection and can be associated with
several adverse effects that can increase the procedure-related morbidity with a potential negative
impact on hospital stay and overall costs.
We have employed VATS performed through sole thoracic epidural anesthesia in awake patients to
resect undetermined lung nodules, solitary metastases and non-small-cell lung cancer in high-risk
patients. Early results have been encouraging although the pros and cons of awake VATS pulmonary
resections still need to be fully elucidated.
Keywords: Pulmonary nodule, VATS, awake thoracic surgery, lung resection.
