1
|
Yang SM, Malwade S, Chung WY, Chen LC, Chang LK, Chang HC, Chan PS, Kuo SW. Nontraumatic intraoperative pulmonary nodule localization with laser guide stamping in a hybrid operating room. Updates Surg 2024:10.1007/s13304-024-01911-6. [PMID: 38872023 DOI: 10.1007/s13304-024-01911-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024]
Abstract
Lung nodule localization using conventional image-guided video-assisted thoracoscopic surgery involves lung puncture, which increases the risk of needle-related complications. We aimed to evaluate the feasibility and safety of a single-stage non-invasive laser-guided stamping localization technique followed by resection under general anesthesia in a hybrid operating room. We retrospectively reviewed consecutive patients who underwent thoracoscopic surgery for small pulmonary nodules using laser-guided dye-stamping localization methods in a hybrid operating room between June 2023 and October 2023. During the study period, 18 patients with 20 lesions underwent single-stage intraoperative image-guided stamping video-assisted thoracoscopic surgery in the hybrid operating room. The median size of the nodules was 7.4 mm (interquartile range [IQR] 5.7-9.8 mm), and median distance from the pleural surface was 9.8 mm (IQR 7.7-14.6 mm). The median localization time was 26 min (IQR 23-34 min), whereas median operation time was 69 min (IQR 62-87 min). The total median operating room time was 146 min (IQR 136-157 min). Twelve patients underwent less than two cone-beam computed tomography scans, while 6 underwent more than two scans. The total median dose area product, including cone-beam computed tomography scans, was 5731.4 uGym2. No localization-related complications were observed, and the postoperative length of stay was 1 day (IQR 1-2 days). The single-stage image-guided pleural stamping technique for localizing small pulmonary nodules in a hybrid operating room is feasible and safe. Future research with larger cohorts is required to further explore the benefits of this workflow.
Collapse
Affiliation(s)
- Shun-Mao Yang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan.
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan.
| | - Shwetambara Malwade
- Department of Advanced Therapies, Siemens Healthcare Limited, Taipei, Taiwan
| | - Wen-Yuan Chung
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Lun-Che Chen
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Ling-Kai Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Hao-Chun Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Pak-Si Chan
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
- Department of Anesthesiology, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Shuenn-Wen Kuo
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan.
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan.
| |
Collapse
|
2
|
Han R, Wang LF, Teng F, Lin J, Xian YT, Lu Y, Wu AL. Presurgical computed tomography-guided localization of lung ground glass nodules: comparing hook-wire and indocyanine green. World J Surg Oncol 2024; 22:51. [PMID: 38336734 PMCID: PMC10858508 DOI: 10.1186/s12957-024-03331-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Presurgical computed tomography (CT)-guided localization is frequently employed to reduce the thoracotomy conversion rate, while increasing the rate of successful sublobar resection of ground glass nodules (GGNs) via video-assisted thoracoscopic surgery (VATS). In this study, we compared the clinical efficacies of presurgical CT-guided hook-wire and indocyanine green (IG)-based localization of GGNs. METHODS Between January 2018 and December 2021, we recruited 86 patients who underwent CT-guided hook-wire or IG-based GGN localization before VATS resection in our hospital, and compared the clinical efficiency and safety of both techniques. RESULTS A total of 38 patients with 39 GGNs were included in the hook-wire group, whereas 48 patients with 50 GGNs were included in the IG group. There were no significant disparities in the baseline data between the two groups of patients. According to our investigation, the technical success rates of CT-based hook-wire- and IG-based localization procedures were 97.4% and 100%, respectively (P = 1.000). Moreover, the significantly longer localization duration (15.3 ± 6.3 min vs. 11.2 ± 5.3 min, P = 0.002) and higher visual analog scale (4.5 ± 0.6 vs. 3.0 ± 0.5, P = 0.001) were observed in the hook-wire patients, than in the IG patients. Occurrence of pneumothorax was significantly higher in hook-wire patients (27.3% vs. 6.3%, P = 0.048). Lung hemorrhage seemed higher in hook-wire patients (28.9% vs. 12.5%, P = 0.057) but did not reach statistical significance. Lastly, the technical success rates of VATS sublobar resection were 97.4% and 100% in hook-wire and IG patients, respectively (P = 1.000). CONCLUSIONS Both hook-wire- and IG-based localization methods can effectively identified GGNs before VATS resection. Furthermore, IG-based localization resulted in fewer complications, lower pain scores, and a shorter duration of localization.
Collapse
Affiliation(s)
- Rui Han
- Department of Interventional Radiology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, China
| | - Long-Fei Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, China
| | - Fei Teng
- Department of Interventional Radiology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, China
| | - Jia Lin
- Department of Interventional Radiology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, China
| | - Yu-Tao Xian
- Department of Interventional Radiology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, China
| | - Yun Lu
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China.
| | - An-Le Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, China.
| |
Collapse
|
3
|
Pezeshkian F, McAllister M, Singh A, Theeuwen H, Abdallat M, Figueroa PU, Gill RR, Kim AW, Jaklitsch MT. What's new in thoracic oncology. J Surg Oncol 2024; 129:128-137. [PMID: 38031889 DOI: 10.1002/jso.27535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023]
Abstract
Many changes have occurred in the field of thoracic surgery over the last several years. In this review, we will discuss new diagnostic techniques for lung cancer, innovations in surgery, and major updates on latest treatment options including immunotherapy. All these have significantly started to change our approach toward the management of lung cancer and have great potential to improve the lives of our patients afflicted with this disease.
Collapse
Affiliation(s)
- Fatemehsadat Pezeshkian
- Division of Thoracic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Miles McAllister
- Division of Thoracic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anupama Singh
- Division of Thoracic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hailey Theeuwen
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Mohammad Abdallat
- Division of Thoracic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Paula Ugalde Figueroa
- Division of Thoracic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ritu R Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Anthony W Kim
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael T Jaklitsch
- Division of Thoracic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Pezeshkian F, McAllister M, Singh A, Jaklitsch MT, Gill RR, Bueno R, Coppolino A. Image-guided video-assisted thoracoscopic surgery (iVATS): a single center experience and review. J Thorac Dis 2023; 15:7035-7041. [PMID: 38249864 PMCID: PMC10797359 DOI: 10.21037/jtd-23-1461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/17/2023] [Indexed: 01/23/2024]
Abstract
Lung cancer screening techniques using low-dose computed tomography (LDCT) scans have improved over the last decade. This means that there is an increased rate of detection of small, often non-palpable, nodules and ground-glass opacities. Obtaining a definitive diagnosis of these nodules using techniques such as percutaneous image-guided biopsy or intraoperative localization is challenging, and these nodules have traditionally undergone routine surveillance. Image-guided video-assisted thoracoscopic surgery (iVATS), which is performed in a hybrid operating room, has made it more feasible to biopsy and resect these nodules. The first thoracic surgery hybrid operative room was introduced at our institution at Brigham and Women's Hospital. Herein, we describe our experience implementing this technique including the methods we used to train key personnel such as radiologists, surgeons, and anesthesiologists to ensure that this technique successfully translated to a clinical setting. We review the benefits of iVATS, which includes decreased rate of fiducial dislodgement, real-time imaging which facilitates successful fiducial placement, and smaller sized resection of lung parenchyma. We will also describe the comparisons between traditional diagnostic methods and iVATS, patient selection criteria and important technical details. Some centers describe alternative techniques for several of the technical aspects, including patient positioning, which we also mention. Lastly, we describe adverse events after iVATS, which are comparable to those seen after a standard VATS.
Collapse
Affiliation(s)
| | - Miles McAllister
- Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Anupama Singh
- Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Ritu R. Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Raphael Bueno
- Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Antonio Coppolino
- Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| |
Collapse
|
5
|
Yang SM, Chung WY, Ko HJ, Chen LC, Chang LK, Chang HC, Kuo SW, Ho MC. Single-stage augmented fluoroscopic bronchoscopy localization and thoracoscopic resection of small pulmonary nodules in a hybrid operating room. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 63:6827798. [PMID: 36377779 DOI: 10.1093/ejcts/ezac541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Hybrid operating rooms (HOR) have been increasingly used for image-guided lung surgery, and most surgical teams have used percutaneous localization for small pulmonary nodules. We evaluated the feasibility and safety of augmented fluoroscopic bronchoscopy localization under endotracheal tube intubation general anaesthesia followed by thoracoscopic surgery as a single-stage procedure in ab HOR. METHODS We retrospectively reviewed clinical records of patients who underwent single-stage augmented fluoroscopic bronchoscopy localization under general anaesthesia followed by thoracoscopic surgery in an HOR between August 2020 and March 2022. RESULTS Single-stage localization and resection were performed for 85 nodules in 74 patients. The median nodule size was 8 mm [interquartile range (IQR), 6-9 mm], and the median distance from the pleural space was 10.9 mm (IQR, 8-20 mm). All nodules were identifiable on cone-beam computed tomography images and marked transbronchially with indigo carmine dye (median markers per lesion: 3); microcoils were placed for deep margins in 16 patients. The median localization time was 30 min (IQR 23-42 min), and the median fluoroscopy duration was 3.3 min (IQR 2.2-5.3 min). The median radiation exposure (expressed as the dose area product) was 4303.6 μGym2 (IQR 2879.5-6268.7 μGym2). All nodules were successfully marked and resected, and the median global operating room time was 178.5 min (IQR 153.5-204 min). There were no localization-related complications, and the median length of postoperative stay was 1 day (IQR, 1-2 days). CONCLUSIONS Single-stage augmented fluoroscopic bronchoscopy localization under general anaesthesia followed by thoracoscopic surgery was feasible and safe.
Collapse
Affiliation(s)
- Shun-Mao Yang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan.,Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Wen-Yuan Chung
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Hang-Jang Ko
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Lun-Che Chen
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Ling-Kai Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Hao-Chun Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Shuenn-Wen Kuo
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan.,Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| |
Collapse
|
6
|
Role of subxiphoid uniportal video-assisted thoracoscopic surgery in pulmonary metastasectomy. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2022; 19:232-239. [PMID: 36643341 PMCID: PMC9809182 DOI: 10.5114/kitp.2022.122094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 10/12/2022] [Indexed: 01/03/2023]
Abstract
Optimal management for patients with pulmonary metastasis is still debated. True survival benefit from widely practiced pulmonary metastasectomy (PM) is yet to be proved from high-quality randomized controlled trials. The ideal surgical approach for PM is also not generally agreed. VATS offers enhanced recovery and superior functional outcomes but at the expense of less detection of lung nodules and higher possibility of narrow/positive resection margins. The subxiphoid uniportal VATS (uVATS) approach is an evolving new approach with potential advantages including simultaneous access to both lung fields, less pain and faster rehabilitation. These advantages make it a favorable approach for PM, particularly in the setting of bilateral metastases. However, its use is still limited to case reports of a small number of patients. There is room for improvements in subxiphoid uVATS due to reported technical challenges and limitations. Herein, we aim to publicize a comprehensive review of literature on applications of subxiphoid uVATS in PM.
Collapse
|
7
|
Saif A, Ryan C, Hernandez JM, Bueno R. Image-Guided Video-Assisted Thoracoscopic Surgery (iVATS) Versus Standard VATS Resection. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11585-2. [PMID: 35412204 DOI: 10.1245/s10434-022-11585-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/26/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Areeba Saif
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Carrie Ryan
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jonathan M Hernandez
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Raphael Bueno
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| |
Collapse
|
8
|
Cheng YF, Hsieh YC, Chang YJ, Cheng CY, Huang CL, Hung WH, Wang BY. Comparison of extended segmentectomy with traditional segmentectomy for stage I lung cancer. J Cardiothorac Surg 2022; 17:27. [PMID: 35246181 PMCID: PMC8895589 DOI: 10.1186/s13019-022-01771-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For stage I non-small cell lung cancer (NSCLC), lobectomy and segmentectomy are still controversial operations. Extended segmentectomy was proposed to make larger safe margins than segmentectomy. Image-guided video-assisted thoracoscopic surgery (iVATS) is useful to accomplish extended segmentectomy. We aimed to compare the effects of iVATS extended segmentectomy to the effects of traditional segmentectomy for stage I NSCLC. METHODS This study is a retrospective analysis in a single institute. Patients with stage I NSCLC who received segmentectomy between January 2017 and September 2020 were included. Patients were distributed to iVATS extended segmentectomy (group A), and traditional segmentectomy (group B). The impacts of the different surgical methods on resection margin were assessed. RESULTS There were 116 patients enrolled in this study. Sixty-two patients distributed in group A, and the other 54 patients in group B. The resection margin to a staple line was 17.94 mm in group A versus 14.15 mm in group B, p = 0.037. The margin/tumor diameter ratio was 2.08 in group A versus 1.39 in group B, p = 0.003. The enough margin rate was 75.81% and 57.41%, respectively, for group A and group B. The subgroup analysis of iVATS extended segmentectomy showed that T1a lesions had larger margin distances than did T1b lesions (19.85 mm vs. 14.83 mm, p = 0.026). CONCLUSIONS The iVATS extended segmentectomy can provide more resection margin than traditional segmentectomy. Segmentectomy is more suitable to perform when the nodule's diameter is less than 10 mm.
Collapse
Affiliation(s)
- Ya-Fu Cheng
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua County, No. 135 Nanxiao St., Changhua City, 500, Taiwan, ROC
| | - Yueh-Che Hsieh
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
| | - Yu-Jun Chang
- Big Data Center, Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan, ROC
| | - Ching-Yuan Cheng
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua County, No. 135 Nanxiao St., Changhua City, 500, Taiwan, ROC
| | - Chang-Lun Huang
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua County, No. 135 Nanxiao St., Changhua City, 500, Taiwan, ROC
| | - Wei-Heng Hung
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua County, No. 135 Nanxiao St., Changhua City, 500, Taiwan, ROC
| | - Bing-Yen Wang
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua County, No. 135 Nanxiao St., Changhua City, 500, Taiwan, ROC. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC. .,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC. .,Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan, ROC. .,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC. .,Center for General Education, Ming Dao University, Changhua, Taiwan, ROC.
| |
Collapse
|
9
|
Li C, Zheng Y, Yuan Y, Li H. Augmented reality navigation-guided pulmonary nodule localization in a canine model. Transl Lung Cancer Res 2022; 10:4152-4160. [PMID: 35004246 PMCID: PMC8674612 DOI: 10.21037/tlcr-21-618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022]
Abstract
Background The current intraoperative pulmonary nodule localization techniques require specific medical equipment or skillful operators, which limits their widespread application. Here, we present an innovative nodule localization technique in a canine lung model using augmented reality (AR) navigation. Methods Peripheral pulmonary lesions were artificially created in canine model. A preoperative chest computed tomography scan was performed for each animal. The acquired computed tomography images were analyzed, and an established intraoperative localization plan was uploaded into HoloLens (a head-mounted AR device). Under general anesthesia, lung localization markers were implanted in each canine, guided by the established procedure plan displayed by HoloLens. All artificial lesions and markers were removed by video-assisted wedge resection or lobectomy in a single operation. Results Since June 2019, 12 peripheral pulmonary lesions were artificially created in 4 canine models. All lung localization markers were precisely implanted with a median registration and implantation time of 6 minutes (range, 2–15 minutes). The average distance between pulmonary lesions and markers was 1.9±1.7 mm, based on computed tomography examination after localization. No severe pneumothorax was observed after marker implantation. After an average implantation period of 16.5 days, no marker displacement was observed. Conclusions The AR navigation-guided pulmonary nodule localization technique was safe and effective in a canine model. The validity and feasibility of using this technology in patients will be examined further (NCT04211051).
Collapse
Affiliation(s)
- Chengqiang Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuyan Zheng
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ye Yuan
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
10
|
Harrison OJ, Sarvananthan S, Tamburrini A, Peebles C, Alzetani A. Image-guided combined ablation and resection in thoracic surgery for the treatment of multiple pulmonary metastases: A preliminary case series. JTCVS Tech 2021; 9:156-162. [PMID: 34647088 PMCID: PMC8500989 DOI: 10.1016/j.xjtc.2021.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives To demonstrate the feasibility and preliminary outcomes of a novel hybrid technique combining percutaneous microwave ablation and wire-assisted wedge resection for patients with multiple pulmonary metastases using intraoperative imaging. Methods We describe our technique and present a retrospective case series of 4 patients undergoing iCART at our institution between August 2018 and January 2020. Procedures were performed in a hybrid operating suite using the ARTIS Pheno cone beam computerized tomography scanner (Siemens Healthineers, Erlangen, German). Patient information included past history of malignancy as well as lesion size, depth, location, and histology result. Surgical complications and length of stay were also recorded. Results Five procedures were performed on 4 patients during the study period. One patient underwent bilateral procedures 4 weeks apart. All patients underwent at least 1 ablation and 1 wedge resection during the combined procedure. Patient ages ranged from 40 to 66 years and the majority (75%) were men. All had a past history of cancer. Lesions were treated in every lobe. Size and depth ranged from 6 to 24 mm and 21 to 33 mm, respectively, for ablated nodules and 5 to 27 mm and 0 to 22 mm, respectively, for the wedge resected nodules. Three procedures were completed uniportal and operative time ranged from 51 to 210 minutes. All cases sustained <10 mL blood loss. There were 2 intraoperative pneumothorax, 1 prevented successful completion of the ablation. One patient required a prolonged period of postoperative physiotherapy and was discharged on day 6. The other patients were discharged on postoperative day 2 or 3. All 5 histology specimens confirmed metastatic disease. Conclusions Our hybrid approach provides a minimally invasive and comprehensive personalized therapy for patients with multiple pulmonary metastases under a single general anesthetic. It provides histology-based diagnosis whilst minimizing lung tissue loss and eliminating the need for transfer from radiology to operating theatre. Emergence of ablation as a treatment for stage 1 non–small cell lung cancer and the expansion of lung cancer screening may widen the application of iCART in the future.
Collapse
Affiliation(s)
- Oliver J Harrison
- Department of Thoracic Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - Sajiram Sarvananthan
- Department of Thoracic Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - Alessandro Tamburrini
- Department of Thoracic Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - Charles Peebles
- Department of Cardiothoracic Radiology, University Hospital Southampton, Southampton, United Kingdom
| | - Aiman Alzetani
- Department of Thoracic Surgery, University Hospital Southampton, Southampton, United Kingdom
| |
Collapse
|
11
|
Melloni G, Venturino M, Mazza F, Turello D. Use of the hybrid room for thoracic surgery procedures: single-stage localization and removal of non-palpable nodules. Indian J Thorac Cardiovasc Surg 2020; 37:70-77. [PMID: 33442209 DOI: 10.1007/s12055-020-00997-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022] Open
Abstract
With the widespread availability of lung cancer screening programs, the number of small lung nodules requiring histological characterization has dramatically increased. Because computed tomography-guided fine-needle aspiration may frequently yield false-negative results, excisional biopsy using thoracoscopy is frequently required. Although thoracoscopic procedure has been known to be ideal for nodule resection, the identification of very small, subsolid and deep pulmonary nodules may still be challenging. Precise lesion localization is a key prerequisite to avoid conversion to an unplanned thoracotomy. In the traditional workflow, the localization procedure is performed in the radiology suite, after which the patient is moved to an operating room. With the availability of hybrid operating rooms, a new approach encompassing simultaneous localization and removal of non-palpable lung nodules has become feasible. In this article, we review the procedural workflow of this new technique and discuss its indications and results.
Collapse
Affiliation(s)
- Giulio Melloni
- Department of Thoracic Surgery, Cuneo General Hospital, Via Michele Coppino, 26, 12100 Cuneo, Italy
| | - Massimiliano Venturino
- Department of Thoracic Surgery, Cuneo General Hospital, Via Michele Coppino, 26, 12100 Cuneo, Italy
| | - Federico Mazza
- Department of Thoracic Surgery, Cuneo General Hospital, Via Michele Coppino, 26, 12100 Cuneo, Italy
| | - Davide Turello
- Department of Thoracic Surgery, Cuneo General Hospital, Via Michele Coppino, 26, 12100 Cuneo, Italy
| |
Collapse
|
12
|
Gill RR, Bueno R. Image-assisted video assisted thoracic surgery (iVATS): an important tool in the armamentarium against lung cancer. J Thorac Dis 2020; 12:1766-1769. [PMID: 32642081 PMCID: PMC7330288 DOI: 10.21037/jtd-20-1693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ritu R Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Raphael Bueno
- Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA
| |
Collapse
|
13
|
Gill RR, Barlow J, Jaklitsch MT, Schmidlin EJ, Hartigan PM, Bueno R. Image-guided video-assisted thoracoscopic resection (iVATS): Translation to clinical practice-real-world experience. J Surg Oncol 2020; 121:1225-1232. [PMID: 32166751 PMCID: PMC7383497 DOI: 10.1002/jso.25897] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/26/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We developed a novel approach for localization and resection of lung nodules, using image-guided video-assisted thoracoscopic surgery (iVATS). We report our experience of translating iVATS into clinical care. METHODS Methodology and workflow for iVATS developed as part of the Phase I/II trial were used to train surgeons, radiologists, anesthesiologists, and radiology technologists. Radiation dose, time from induction to incision, placement of T-bar to incision and incision to closure, hospital stay, and complication rates were recorded. RESULTS Fifty patients underwent iVATS for resection of 54 nodules in a clinical hybrid operating room (OR) by six surgeons. Fifty-two (97%) nodules were successfully resected. Forty-two (84%) patients underwent wedge resection, four (7%) lobectomies, and two (4%) segmentectomy all with lymph node dissection. Median time from induction to incision was 89 minutes (range: 13-256 minutes); T-bar placement was 14 minutes (10-29 minutes); and incision to closure, 107 minutes (41-302 minutes). Average and total procedure radiation dose were: median = 6 mSieverts (range: 2.9-35 mSieverts). No deaths were reported and median length of stay was 3 days (range: 1-12 days). CONCLUSIONS Translation of iVATS into clinical practice has been initiated using a safe step-wise process, combining intraoperative C-arm computed tomography scanning and thoracoscopic surgery in a hybrid OR.
Collapse
Affiliation(s)
- Ritu R. Gill
- Department of RadiologyBeth Israel Deaconess Medical CenterBostonMassachusetts
| | - Julianne Barlow
- Department of SurgeryBrigham & Women's HospitalBostonMassachusetts
| | | | - Eric J. Schmidlin
- Department of RadiologyBrigham & Women's HospitalBostonMassachusetts
| | - Phillip M. Hartigan
- Department of Anesthesiology Perioperative and Pain MedicineBrigham & Women's HospitalBostonMassachusetts
| | - Raphael Bueno
- Department of SurgeryBrigham & Women's HospitalBostonMassachusetts
| |
Collapse
|