Each of the patients whose chest roentgenograms are shown may have video-assisted thoracic surgery (VATS) EXCEPT:

A.

B. 

C. 

D. 

E. 

Answer D

Video-assisted thoracic surgery (VATS) has allowed relatively complex intrathoracic procedures to be performed utilizing minimally invasive techniques. The indications for VATS are not yet firmly established. However, talc pleurodesis for a malignant effusion (A), treatment of a recurrent spontaneous pneumothorax (B), and wedge resection of an indeterminate pulmonary nodule (C) or for biopsy of pulmonary tissue for diagnostic purposes (E) are all accepted indications for VATS. 

All wedge resections require collapse of the ipsilateral lung to provide a space in which the operator and equipment can work; thus, in patients who have had a pneumonectomy (D), VATS resection of a nodule in the remaining lung is not possible. In addition, there have been several instances where malignant cells have been implanted into the chest wall during a VATS wedge excision of a cancer. Therefore, if a nodule is deep-seated or if visibility is poor, conversion to an open procedure is prudent.