Precision Cautery Excision of Deep-Seated Lung Hamartoma by Video Assisted Thoracoscopic Surgery (VATS)

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By Thirugnanam Agasthian, MBBS, FRCS, MMed

Precision cautery excision, or the Perelman procedure, is ideal for:

1. Resection of multiple lung lesions as in metastasectomy where preservation of lung tissue is important.
2. Deep-seated lesions where placement of staplers is precluded by the thickness of the lung tissue.

The principle behind this technique is to core out the nodule from the surrounding lung parenchyma with adequate margins using electrocautery. Though traditionally done through thoracotomy with the lung in the semi-inflated stage, this video demonstrates the use of this technique through VATS in a 32 years old asymptomatic lady with a deep-seated right upper lobe hamartoma. The VATS procedure is done totally endoscopically under direct monitor vision. After placement of the ports the nodule is localized by digital palpation and a hook cautery is used to surface mark the location of the nodule. The lung parenchyma is then gradually divided until the nodule is visualized. The hamartoma is then enucleated with the help of a traction suture placed through the nodule. After securing hemostasis the lung is re-approximated in 2 layers using a continuous 4-0 Prolene suture. The suturing is done intracorporeally. The patient had an uneventful recovery.

The video can also be viewed, larger, in a new window: Precision Cautery Excision of Deep-Seated Lung Hamartoma by Video Assisted Thoracoscopic Surgery (VATS)