Video-assisted thoracoscopic segmentectomy is feasible, safe and effective in selected cases of pulmonary aspergilloma.

BACKGROUND: This study evaluates the feasibility and safety of video-assisted thoracoscopic segmentectomy in selected aspergilloma patients.

METHODS: This retrospective study included eight patients who underwent VATS segmentectomy for aspergilloma. Patient demographics, clinical presentation, imaging characteristics, and operative details were analyzed. The primary objective was complete resection of the lesion, while secondary objectives included postoperative complications and hospital stay duration.

RESULTS: The cohort included 6 males (75%) and 2 females (25%), with a median age of 37 ± 14.9 years. All patients (n = 8 patients, 100%) presented with hemoptysis, while (n = 4, 50%) had a history of tuberculosis. Pre-operative chest CT imaging revealed cavitary lesions in 7 patients (87.5%), fibrosis in 6 (75%), and bronchiectasis in 5 (62.5%) patients. VATS segmentectomy was completed in 7 patients (87.5%), while 1 (12.5%) required postero-lateral thoracotomy due to extensive hilar adhesions. The mean lesion size was 2.8 ± 1.1 cm, and histopathological analysis confirmed aspergilloma in all patients. Postoperative complications were observed in 2 patients (25%). There was no mortality. The mean duration of ICD was 3.7 ± 0.9 days, and the overall hospital stay averaged 4.4 ± 1.9 days. No recurrence of the symptoms or disease was observed in the median follow-up of 23 months.

CONCLUSION: VATS Segmentectomy is a feasible, safe, and effective surgical approach for managing selected aspergilloma cases. Conversion to thoracotomy may be necessary in cases with extensive adhesions or complex anatomy, highlighting the need for meticulous pre-operative surgical planning.