Pre-operative: Preoperative preparations include disease medical condition explanation, preoperative anesthesia visits, and deep breathing exerciser training.

Surgery:

Pulmonary nodules will be localized by chest surgeons or radiologists, then minimally invasive video assisted thoracoscopic surgery (VATS) is performed under general anesthesia or non-intubated under heavy sedation. Localized lesions will be recognized and successfully resected under marking.

The VATS approach has proven to be superior to thoracotomy in many regards. The VATS approach can be performed via multiple ports, usually 2–4 incisions without rib spreading to evolve to single-port approach.

In Taipei Veterans General Hospital, the evolution of the thoracoscopic surgery has moved to less invasive techniques. Uniportal VATS had been developed for many years. Currently, uniportal VATS followed by localization is a routine procedure for patients with small ground glass opacity, which may reduce postoperative pain and lead to faster recovery. Complications of surgery are minimal, which resulted in early mobilization and decreased hospital stay.

For patients with old age or limited pulmonary function, alternative treatment methods can be provided in our hospital. Cryoablation is a procedure that utilizes cold liquid nitrogen to treat cancer. Accurate localization is also applied on cryoprobe to freeze the tissue.

Post-operative:

# Daily wound care

# Adequate pain control

# Chest drainage tube care

# Encourage ambulation

Notification

Risks and complications associated with VATS surgery include:

# Bleeding

# Wound pain/infection/poor healing

# Pneumothorax/hemothorax/chylothorax

# Pneumonia/sepsis/respiratory failure/shock

Estimated Cost

The expense for these procedures varies from 30,000-100,000 NTD in accordance with the actual medical expenses.