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Hung W, Tsai SC, Wu T, Tu H, Lin H, Su C, Wu Y, Lin L, Lin FC. Enhancing precision in lung tumor ablation through innovations in CT-guided technique and angle control. Thorac Cancer 2024; 15:867-877. [PMID: 38419563 PMCID: PMC11016418 DOI: 10.1111/1759-7714.15255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND This retrospective study aimed to evaluate the precision and safety outcomes of image-guided lung percutaneous thermal ablation (LPTA) methods, focusing on radiofrequency ablation (RFA) and microwave ablation (MWA). The study utilized an innovative angle reference guide to facilitate these techniques in the treatment of lung tumors. METHODS This study included individuals undergoing LPTA with the assistance of laser angle guide assembly (LAGA) at our hospital between April 2011 and March 2021. We analyzed patient demographics, tumor characteristics, procedure details, and complications. Logistic regressions were employed to assess risk factors associated with complications. RESULTS A total of 202 patients underwent ablation for 375 lung tumors across 275 sessions involving 495 ablations. Most procedures used RFA, especially in the right upper lobe, and the majority of ablations were performed in the prone position (49.7%). Target lesions were at a median depth of 39.3 mm from the pleura surface, and remarkably, 91.9% required only a single puncture. Complications occurred in 31.0% of ablations, with pneumothorax being the most prevalent (18.3%), followed by pain (12.5%), sweating (6.5%), fever (5.0%), cough (4.8%), hemothorax (1.6%), hemoptysis (1.2%), pleural effusion (2.0%), skin burn (0.6%), and air emboli (0.2%). The median procedure time was 21 min. Notably, smoking/chronic obstructive pulmonary disease emerged as a significant risk factor for complications. CONCLUSION The LAGA-assisted LPTA enhanced safety by improving accuracy and reducing risks. Overall, this investigation contributes to the ongoing efforts to refine and improve the clinical application of these thermal ablation techniques in the treatment of lung tumors.
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Affiliation(s)
- Wei‐Te Hung
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
| | - Stella Chin‐Shaw Tsai
- Superintendent OfficeTaichung MetroHarbor HospitalTaichungTaiwan
- Department of Post‐Baccalaureate Medicine, College of MedicineNational Chung Hsing UniversityTaichungTaiwan
| | - Tzu‐Chin Wu
- Department of Thoracic MedicineChung Shan Medical University HospitalTaichungTaiwan
| | - Hsien‐Tang Tu
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
- Department of Thoracic MedicineChung Shan Medical University HospitalTaichungTaiwan
| | - Huan‐Cheng Lin
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
- Department of Thoracic SurgeryChung Shan Medical University HospitalTaichungTaiwan
| | - Chun‐Lin Su
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
| | - Yu‐Chieh Wu
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
| | - Li‐Cheng Lin
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
| | - Frank Cheau‐Feng Lin
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
- Department of Thoracic SurgeryChung Shan Medical University HospitalTaichungTaiwan
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Wang Y, Jing L, Liang C, Liu J, Wang S, Wang G. Comparison of the safety and effectiveness of the four-hook needle and hook wire for the preoperative positioning of localization ground glass nodules. J Cardiothorac Surg 2024; 19:35. [PMID: 38297385 PMCID: PMC10829251 DOI: 10.1186/s13019-024-02497-1] [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: 03/03/2023] [Accepted: 01/14/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND With the implementation of lung cancer screening programs, an increasing number of pulmonary nodules have been detected.Video-assisted thoracoscopic surgery (VATS) could provide adequate tissue specimens for pathological analysis, and has few postoperative complications.However, locating the nodules intraoperatively by palpation can be difficult for thoracic surgeons. The preoperative pulmonary nodule localization technique is a very effective method.We compared the safety and effectiveness of two methods for the preoperative localization of pulmonary ground glass nodules. METHODS From October 2020 to April 2021, 133 patients who underwent CT-guided single pulmonary nodule localization were retrospectively reviewed. All patients underwent video-assisted thoracoscopic surgery (VATS) after successful localization. Statistical analysis was used to evaluate the localization accuracy, safety, information related to surgery and postoperative pathology information. The aim of this study was to evaluate the clinical effects of the two localization needles. RESULTS The mean maximal transverse nodule diameters in the four-hook needle and hook wire groups were 8.97 ± 3.85 mm and 9.00 ± 3.19 mm, respectively (P = 0.967). The localization times in the four-hook needle and hook wire groups were 20.58 ± 2.65 min and 21.43 ± 3.06 min, respectively (P = 0.09). The dislodgement rate was significantly higher in the hook wire group than in the four-hook needle group (7.46% vs. 0, P = 0.024). The mean patient pain scores based on the visual analog scale in the four-hook needle and hook wire groups were 2.87 ± 0.67 and 6.10 ± 2.39, respectively (P = 0.000). All ground glass nodules (GGNs) were successfully resected by VATS. CONCLUSIONS Preoperative pulmonary nodule localization with both a four-hook needle and hook wire is safe, convenient and effective.
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Affiliation(s)
- Yongming Wang
- Department of Thoracic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong, China
- Department of Thoracic Surgery, Weifang No.2 Peoplès Hospital, Weifang, 261041, Shandong, China
| | - Lijun Jing
- Department of Anesthesiology, Weifang No.2 Peoplès Hospital, Weifang, 261041, Shandong, China
| | - Changsheng Liang
- Department of Radiology, Weifang No.2 Peoplès Hospital, Weifang, 261041, Shandong, China
| | - Junzhong Liu
- Department of Radiology, Weifang No.2 Peoplès Hospital, Weifang, 261041, Shandong, China
| | - Shubo Wang
- Department of Thoracic Surgery, Weifang No.2 Peoplès Hospital, Weifang, 261041, Shandong, China
| | - Gongchao Wang
- Department of Thoracic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong, China.
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Wei W, Wang SG, Zhang JY, Togn XY, Li BB, Fang X, Pu RW, Zhou YJ, Liu YJ. Implementation of Individualized Low-Dose Computed Tomography-Guided Hook Wire Localization of Pulmonary Nodules: Feasibility and Safety in the Clinical Setting. Diagnostics (Basel) 2023; 13:3235. [PMID: 37892056 PMCID: PMC10606229 DOI: 10.3390/diagnostics13203235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/06/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Background: CT-guided hook-wire localization is an essential step in the management of small pulmonary nodules. Few studies, however, have focused on reducing radiation exposure during the procedure. Purpose: This study aims to explore the feasibility of implementing a low-dose computed tomography (CT)-guided hook wire localization using tailored kVp based on patients' body size. Materials and Methods: A total of 151 patients with small pulmonary nodules were prospectively enrolled for CT-guided hook wire localization using individualized low-dose CT (LDCT) vs. standard-dose CT (SDCT) protocols. Radiation dose, image quality, characteristics of target nodules and procedure-related variables were compared. All variables were analyzed using Chi-Square and Student's t-test. Results: The mean CTDIvol was significantly reduced for LDCT (for BMI ≤ 21 kg/m2, 0.56 ± 0.00 mGy and for BMI > 21 kg/m2, 1.48 ± 0.00 mGy) when compared with SDCT (for BMI ≤ 21 kg/m2, 5.24 ± 0.95 mGy and for BMI > 21 kg/m2, 6.69 ± 1.47 mGy). Accordingly, the DLP of LDCT was significantly reduced as compared with that of SDCT (for BMI ≤ 21 kg/m2, 56.86 ± 4.73 vs. 533.58 ± 122.06 mGy.cm, and for BMI > 21 kg/m2, 167.02 ± 38.76 vs. 746.01 ± 230.91 mGy.cm). In comparison with SDCT, the effective dose (ED) of LDCT decreased by an average of 89.42% (for BMI ≤ 21 kg/m2) and 77.68% (for BMI > 21 kg/m2), respectively. Although the images acquired with the LDCT protocol yielded inferior quality to those acquired with the SDCT protocol, they were clinically acceptable for hook wire localization. Conclusions: LDCT-guided localization can provide safety and nodule detection performance comparable to SDCT-guided localization, benefiting radiation dose reduction dramatically, especially for patients with small body mass indexes.
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Affiliation(s)
| | | | | | | | | | | | | | - Yu-Jing Zhou
- Correspondence: (Y.-J.Z.); (Y.-J.L.); Tel.: +86-180-9887-7000 (Y.J.-L.)
| | - Yi-Jun Liu
- Correspondence: (Y.-J.Z.); (Y.-J.L.); Tel.: +86-180-9887-7000 (Y.J.-L.)
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Tian Y, An J, Zou Z, Dong Y, Wu J, Chen Z, Niu H. Computed Tomography-Guided Microcoil Localization of Pulmonary Nodules: Effects of Multiple Punctures. Thorac Cardiovasc Surg 2023; 71:566-572. [PMID: 34963179 DOI: 10.1055/s-0041-1736244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of the study is to analyze the effect of multiple punctures in computed tomography (CT)-guided microcoil localization of pulmonary nodules with other risk factors for common complications. METHODS Consecutive patients who underwent CT-guided microcoil localization and subsequent video-assisted thoracoscopic surgery (VATS) between January 2020 and February 2021 were enrolled. Nodules successfully located after only one puncture were defined as the single puncture group, and nodules requiring two or more punctures were defined as the multiple puncture group. Binary logistic regression analysis was performed to assess the relationship between the number of punctures and pneumothorax and intrapulmonary hemorrhage. RESULTS A total of 121 patients were included. There were 98 (68.1%) pulmonary nodules in the single puncture group compared with 46 (31.9%) nodules in the multiple puncture group. The frequencies of pneumothorax and intrapulmonary hemorrhage were higher in the multiple puncture group than in the single puncture group (p = 0.019 and <0.001, respectively). Binary logistic regression demonstrated that independent risk factors for developing pneumothorax included lateral positioning of the patient (p < .001) and prone positioning (p = 0.014), as well as multiple punctures (p = 0.013). Independent risk factors for intrapulmonary hemorrhage included the distance between the distal end of the coil and the surface of the pleura (p = 0.033), multiple punctures (p = 0.003), and passage through the pulmonary vasculature (p < 0.001). CONCLUSION Multiple punctures resulted in an increased incidence of pneumothorax and intrapulmonary hemorrhage compared with single puncture during CT-guided microcoil localization of pulmonary nodules and were independently associated with both pneumothorax and intrapulmonary hemorrhage.
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Affiliation(s)
- Ye Tian
- Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, People's Republic of China
| | - Jianli An
- Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, People's Republic of China
| | - Zibo Zou
- Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, People's Republic of China
| | - Yanchao Dong
- Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, People's Republic of China
| | - Jingpeng Wu
- Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, People's Republic of China
| | - Zhuo Chen
- Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, People's Republic of China
| | - Hongtao Niu
- Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, People's Republic of China
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Tsai CY, Tsai SCS, Shen GQ, Guo GLR, Tsui ZLG, Hsieh MY, Yuan C, Lin FCF. Simulation education utilizing phantom and angle reference guide in pulmonary nodule CT localization. Heliyon 2023; 9:e18329. [PMID: 37539172 PMCID: PMC10395521 DOI: 10.1016/j.heliyon.2023.e18329] [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: 11/16/2022] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023] Open
Abstract
Objective The incidence of sub-centimeter pulmonary nodules has been increasing along with the use of low-dose computed tomography (LDCT) as a screening tool for early lung cancer detection. In our institution, pulmonary nodule computed tomography-guided localization (PNCL) is performed preoperatively with the laser angle guided assembly (LAGA), an angle reference device. This study aims to investigate the efficacy of postgraduate education in a phantom simulation of PNCL, with or without LAGA. Setting design This prospective study was conducted in an academic hospital in Taiwan. Seven thoracic surgery residents and three experienced senior physicians were recruited to perform PNCL using a phantom simulation, with or without LAGA, for five nodules each and complete a questionnaire. Performance data were collected. χ2 tests, Mann-Whitney U test, univariate and multivariate linear regression were used for statistical analyses. Results The confidence level increased from median 7[range 1, 9] to 8, range [6,9] (p = 0.001) before and after the simulation education course. The scores of enhanced PNCL ability and course satisfaction were as high as 8 [5,9], and 9 [7,9]. LAGA enabled broader puncture angles (with 27.5° [0°,80°]; without 14° [0°, 80°], p = 0.003), a lower puncture frequency (with 1 [1,4]; without 2 [1,5], p < 0.001), and a smaller angle deviation (with 3°[ 0°,8°]; without 5°[ 0°,19°], p = 0.002). Pleural depth in millimeters was associated with increased puncture frequency (0.019[0,010,0.028]) and procedure time (0.071'[ 0.018,0.123']. The PNCL-experienced physicians performed the procedure in less time (-2.854'[-4.646',1.061']. The traverse direction toward the mediastinum diminished the frequency (toward 1[ 1,3]; away 1 [1,5], p = 0.003) and time (toward 7.5'[2',18]'; away 9'[ 3',31'], p = 0.027). The learning curve did not improve procedure performance after ten PNCL simulation rounds. Conclusions The phantom PNCL simulation education course increased the confidence level, enhanced residents' skill acquisition, and promoted learning satisfaction. The angle reference device helped improve the outcomes of the puncture frequency and reduced angle deviation.
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Affiliation(s)
- Chiao-Yun Tsai
- Department of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Stella Chin-Shaw Tsai
- Superintendents' Office, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
- Department of Postbaccalaureate Medicine, School of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Guang-Qian Shen
- Department of Mechanical and Computer-Aided Engineering, Feng Chia University, Taichung, Taiwan
| | - Guan-Liang Robert Guo
- Department of Mechanical and Computer-Aided Engineering, Feng Chia University, Taichung, Taiwan
| | - Zhe-Luen Gerald Tsui
- Department of Mechanical and Computer-Aided Engineering, Feng Chia University, Taichung, Taiwan
| | - Ming-Yu Hsieh
- Department of Pediatric Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cadmus Yuan
- Department of Mechanical and Computer-Aided Engineering, Feng Chia University, Taichung, Taiwan
| | - Frank Cheau-Feng Lin
- Department of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Yang Y, Qin C, Ma Y, Lu Z, Zhang Y, Li T. Application of computed tomography-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm). J Cardiothorac Surg 2023; 18:99. [PMID: 37020219 PMCID: PMC10074372 DOI: 10.1186/s13019-023-02188-3] [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: 08/15/2022] [Accepted: 03/12/2023] [Indexed: 04/07/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the safety and efficacy of the computed tomography (CT)-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm) and to identify the risk factors for localization-related complications. METHODS The medical records of 150 patients with small pulmonary nodules treated from January 2018 to June 2021 were retrospectively analyzed. According to preoperative hook-wire positioning status, they were divided into the localization group (50 cases) or the control group (100 cases). The operation time, intraoperative blood loss, hospital stay, and conversion rate to thoracotomy were recorded and compared between groups. Uni- and multivariate binary logistic regression analysis was used to identify the risk factors for localization-related complications. RESULTS A total of 58 nodules were localized in 50 patients in the localization group, and the localization success rate was 98.3% (57/58). In one case, the positioning pin fell off before wedge resection was performed. The mean nodule diameter was 7.05 mm (range, 2.8-10.0 mm), while the mean depth from the pleura was 22.40 mm (range, 5.47-79.47 mm). There were 8 cases (16%) of asymptomatic pneumothorax, 2 (4%) of intrapulmonary hemorrhage, and 1 (2%) of pleural reaction.The mean operation time of the localization group (103.88 ± 41.74 min) was significantly shorter than that of the control group (133.30 ± 45.42 min) (P < 0.05). The mean intraoperative blood loss of the localization group (44.20 ± 34.17 mL) was significantly lower than that of the control group (112.30 ± 219.90 mL) (P < 0.05). The mean hospital stay of the localization group (7.96 ± 2.34 days) was significantly shorter than that of the control group (9.21 ± 3.25 days).Multivariate binary logistic analysis showed that localization times of small pulmonary nodules in the localization group was an independent risk factor for localization-related pneumothorax. CONCLUSIONS Our results suggest that the CT-guided hook-wire localization technique is beneficial for localizing small pulmonary nodules. Specifically, it is helpful for the diagnosis and treatment of early lung cancer because it can accurately remove lesions, decrease intraoperative blood loss, shorten operation time and hospitalization stay, and reduce thoracotomy conversion rate. Simultaneous positioning of multiple nodules can easily lead to positioning-related pneumothorax.
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Affiliation(s)
- Yuan Yang
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Chenhui Qin
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yue Ma
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zhongting Lu
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yun Zhang
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Tao Li
- Department of Surgical Oncology, Tumor Hospital, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
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Preoperative Localization for Small Pulmonary Nodules Using Anchor with Scaled Suture System. Cardiovasc Intervent Radiol 2022; 45:1868-1873. [PMID: 36229696 DOI: 10.1007/s00270-022-03291-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 09/24/2022] [Indexed: 11/02/2022]
Abstract
PURPOSES This study aimed to describe a new localization technique developed using an anchor with a scaled suture (AWSS) system and to characterize the localization results and post-operative outcomes to evaluate its safety and effectiveness. METHODS This retrospective study was conducted at our centre from October 2020 to December 2021. In total, 328 small pulmonary nodules (sPNs) who underwent pre-operative computed tomography (CT)-guided AWSS system localization followed by wedge resection by video-assisted thoracoscopic surgery (VATS) were enrolled in this study. RESULTS CT-guided AWSS system implantations targeting 328 sPNs were successfully performed. The time spent performing localization was 12.4 ± 4.9 min. After puncture localization, the incidences of pneumothorax, pulmonary haemorrhage, and chest pain were 19.2% (63/328), 25.9% (85/328), and 0.9% (3/328), respectively. The incidence of overall complications was 42.7%. According to the CIRSE classification, there were no major complications. The median localization-VATS interval time was 7 h (range, 1-75 h). In 328 cases (100%), the location of the lesion was determined by palpation of the four-paw anchor in the lung and was successfully resected by VATS, and the correct diagnosis was obtained. CONCLUSION In this series, CT-guided pre-operative localization of pulmonary nodules with the AWSS system was safe and had a high positioning accuracy and success rate.
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Yu H, Tian W, Sun Y, Wu Q, Ma C, Jiao P, Huang C, Li D, Tong H. Localization of small peripheral pulmonary nodules for surgical resection: a new intraoperative technique in hybrid operating room. J Cardiothorac Surg 2022; 17:241. [PMID: 36176000 PMCID: PMC9524030 DOI: 10.1186/s13019-022-02012-4] [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: 12/05/2021] [Accepted: 09/27/2022] [Indexed: 11/28/2022] Open
Abstract
Objective The purpose of this study was to introduce a new feasible and effective intraoperative localization technique for small peripheral pulmonary nodules in hybrid operating room. Methods Between June 2020 and June 2021, the intraoperative localization was performed in 27 patients for 35 small pulmonary nodules at our institution. The procedure was undergone under thoracoscopic observation. After making the VATS ports, a titanium clip was clipped at the visceral pleura as near the pulmonary nodule as possible to be a marker for the nodule. VATS resection was performed next. Results A total of 27 patients were included in this study, including 6 males and 21 females. The median age was 58 years (range 34–78 years). All surgeries were performed by two-port VATS. A total of 35 pulmonary nodules underwent intraoperative localization. The mean diameter of nodules was 10.6 ± 3.7 mm. The distance of nodules to visceral pleura was 8.3 ± 8.7 mm. The mean localization time was 23.3 ± 3.3 min. The median time of C-arm scanning was 3 (range 2–4) times. The median times for clipping were 2 (range 1–3) times. All the nodules were localized successfully and resected precisely. No VATS were converted to thoracotomy. There were no complications related to localization procedures. Conclusions This new intraoperative localization technique was feasible, safe and effective. And also the intraoperative procedure could avoid extra suffering for patients.
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Affiliation(s)
- Hanbo Yu
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Wenxin Tian
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Yaoguang Sun
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Qingjun Wu
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Chao Ma
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Peng Jiao
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Chuan Huang
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Donghang Li
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Hongfeng Tong
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China.
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Huang YY, Liu X, Shi YB, Wang T. Preoperative computed tomography-guided localization for lung nodules: localization needle versus coil. MINIM INVASIV THER 2022; 31:948-953. [PMID: 35130462 DOI: 10.1080/13645706.2022.2034647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the clinical efficacy of computed tomography (CT)-guided localization needle and coil insertion as approaches to preoperative lung nodule (LN) localization. MATERIAL AND METHODS Between January 2018 and December 2019, 52 patients awaiting video-assisted thoracoscopic surgery (VATS) resection underwent CT-guided coil insertion to facilitate LN localization. Additionally, 41 patients underwent CT-guided localization needle insertion between January and June 2021. RESULTS In total, 62 and 54 LNs were localized in 52 and 41 patients in the coil and localization needle groups, respectively, with respective technical localization success rates of 96.8% and 100% (p = .498). The localization needle group exhibited a significantly shorter duration of localization relative to the coil group (p < .001), whereas comparable rates of pneumothorax (p = .918) and hemorrhage (p = .712) were evident in these groups. VATS-guided LN resection procedures achieved 100% technical success rates in both groups, and there were no significant differences between groups with respect to the type of resection (p = .113) or the mean duration of VATS (p = .778). CONCLUSION Coil- and localization needle-based approaches can be successfully used for LN localization prior to VATS resection, with localization needle insertion being associated with a shorter duration of localization.
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Affiliation(s)
- Ya-Yong Huang
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Xia Liu
- Department of Respiratory Disease, Xuzhou Central Hospital, Xuzhou, China
| | - Yi-Bing Shi
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Tao Wang
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
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Huang JY, Tsai SCS, Wu TC, Lin FCF. Puncture frequency predicts pneumothorax in preoperative computed tomography-guided lung nodule localization for video-assisted thoracoscopic surgery. Thorac Cancer 2022; 13:1925-1932. [PMID: 35614380 PMCID: PMC9250843 DOI: 10.1111/1759-7714.14457] [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: 04/07/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 11/28/2022] Open
Abstract
Background Iatrogenic pneumothorax is the most frequent complication in preoperative CT‐guided localization (POCTGL) of lung nodules. We aimed to determine the predictive factors of iatrogenic pneumothorax. Methods We retrospectively analyzed data of consecutive POCTGL procedures in patients who received video‐assisted thoracoscopic surgery (VATS) at our hospital between May 2015 and October 2019. All of our patients utilized laser angle guide assembly to aid in the localization procedures. Results In 610 consecutive POCTGL procedures, 40 (6.6%) patients developed iatrogenic pneumothorax, and complications occurred in 8.5%. Univariate analyses revealed that puncture frequency, male gender, puncture depth, left decubitus position, and nodule near fissure were factors associated with pneumothorax, while multivariate analysis showed that only male gender (odds ratio 3.58, p = 0.012) and puncture frequency (odds ratio 2.39/time, p = 0.0004) determined development of pneumothorax. Further collective analysis on puncture frequency revealed that tumor in a difficult zone (1.33 ± 0.71 vs. 1.19 ± 0.45, p = 0.002), especially adjacent to the mediastinum (1.41 ± 0.75 vs. 1.21 ± 0.52, p = 0.002), angle difference of plan‐to‐practice (r = 0.209, p = < 0.001), depth to skin (r = 0.152, p < 0.001), and depth to pleura (r = 0.164, p < 0.001) were factors related to increased puncture frequency in univariate analyses. Only angle difference of plan‐to‐practice was associated in multivariate analysis (odds ratio: 1.158, p = 0.008). Conclusions Puncture frequency was the key factor in the development of iatrogenic pneumothorax from POCTGL. Other associated factors, especially angle difference, may have affected the puncture frequency and subsequently have some influence on the incidence of iatrogenic pneumothorax.
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Affiliation(s)
- Jin-Yang Huang
- College of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | | | - Tzu-Chin Wu
- Department of Thoracic Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Frank Cheau-Feng Lin
- College of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
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11
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Gilberto GM, Falsarella PM, Andrade JRD, Schmid BP, Mariotti GC, Terra RM, Campos JRMD, Succi JE, Garcia RG. Lung nodule localization in hybrid room before minimally invasive thoracic surgery: series of 20 cases and literature review. EINSTEIN-SAO PAULO 2022; 20:eAO6665. [PMID: 35476085 PMCID: PMC9000983 DOI: 10.31744/einstein_journal/2022ao6665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/12/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To describe an experience in the preoperative localization of small pulmonary nodules and ground-glass lesions to guide minimally invasive thoracic surgery; in addition, a literature review was conducted, including the main advantages and disadvantages of the different agents used, and site marking in a hybrid operating room. Methods A retrospective search was conducted in a Interventional Radiology Department database, between March 2015 and May 2019, to identify patients undergoing preoperative percutaneous marking of lung injuries measuring up to 25mm. Results A total of 20 patients were included and submitted to descriptive analysis. All patients were marked in a hybrid room, at the same surgical-anesthetic time. Most often used markers were guidewire, Lipiodol® and microcoils. Despite one case of coil displacement, two cases of pneumothorax, and one case of hypotension after marking, all lesions were identified and resected accordingly from all patients. Conclusion Preoperative percutaneous localization of lung injuries in hybrid room is an effective and a safe technique, which can have decisive impact on surgical resection. The choice of marker and of the operating room scenario should be based on availability and experience of service. Multidisciplinary discussions with surgical teams, pathologists, and interventional radiologists are crucial to improve outcome of patients.
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12
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Yan G, Cheng X, Wu S, Ge Y, Li S, Xuan Y. Clinical value and application of preoperative CT-guided hookwire localization of solitary pulmonary nodules for video-assisted thoracic surgery. Technol Health Care 2022; 30:459-467. [PMID: 35124620 PMCID: PMC9028665 DOI: 10.3233/thc-thc228042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) is a minimally invasive technique for the diagnosis and management of small pulmonary nodular lesions However, the identification of some lung nodules remains difficult. OBJECTIVE This research aimed to investigate the clinical value of preoperative computed tomography (CT)-guided hookwire localization of solitary pulmonary nodules (SPNs) for thoracoscopic resection. METHODS Seventy-one patients with 74 SPNs underwent VATS wedge resection after CT-guided hookwire localization. The mean diameter of the SPNs was 8.50 ± 4.53 mm,,besides, the mean distance from the SPNs to the parietal pleura was 16.81 ± 5.23 mm. RESULTS Sixty-nine of the 74 nodules were successfully localized using a CT-guided hookwire. The success rate of CT-guided localization was 93.2%. The average localization time was 15.23 ± 7.21 min per lesion. Seven patients (9.5%) had asymptomatic pneumothorax and 10 (13.5%) had minimal needle tract parenchymal hemorrhages after localization no clinical intervention was required for these patients. The rate of success for VATS wedge resection of the SPNs was 100%. Histological analysis of the SPNs revealed malignant disease in 67.4% of the patients. CONCLUSIONS Preoperative CT-guided hookwire localization for thoracoscopic resection is a safe and effective operation for the identification and stable fixation of SPNs.
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Affiliation(s)
- Gen Yan
- Department of Radiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian, China
| | - Xiaofang Cheng
- The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
- Department of Radiology, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, Guangdong, China
| | - Shuohua Wu
- Department of Medical Imaging, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yuxi Ge
- Department of Radiology, Affiliated Hospital, Jiangnan University, Wuxi, Jiangsu, China
| | - Shanhua Li
- Department of Basic Medical Sciences, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yinghua Xuan
- Department of Basic Medicine, Xiamen Medical College, Xiamen, Fujian, China
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13
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Jin X, Wang T, Chen L, Xing P, Wu X, Shao C, Huang B, Zang W. Single-Stage Pulmonary Resection via a Combination of Single Hookwire Localization and Video-Assisted Thoracoscopic Surgery for Synchronous Multiple Pulmonary Nodules. Technol Cancer Res Treat 2021; 20:15330338211042511. [PMID: 34516307 PMCID: PMC8442483 DOI: 10.1177/15330338211042511] [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] [Indexed: 11/17/2022] Open
Abstract
Purpose: To retrospectively analyze the incidence and predictors of complications related to hookwire localization in patients with single and multiple nodules, and to evaluate the usefulness of a single-stage surgical method of single hookwire localization combined with video-assisted thoracoscopic surgery (VATS) in synchronous multiple pulmonary nodules (SMPNs). Methods: A total of 200 patients who underwent computed tomography (CT)-guided hookwire localization and subsequent VATS resection were enrolled in this study. For each patient, only 1 indeterminate nodule was implanted with a hookwire. There were 145 patients in the single-nodule group (Group S) and 55 in the multiple-nodule group (Group M). Univariate and binary logistic regression analyses were used to assess incidence and predictors of complications associated with hookwire localization. Results: The technical success rate of hookwire implantation was 97.5%. The incidence of pneumothorax and hookwire dislodgement was 17.0% and 2.5%, respectively. Binary logistic regression analysis showed that 1 transpleural puncture through the pleura (odds ratio [OR] = 0.433, P = .033) was the only independent protective factor for pneumothorax, and pneumothorax (OR = 26.114, P < .01) was the only independent risk factor for dislodgement. The volume of blood loss during VATS was significantly higher in group M than in group S, and the time of postoperative hospitalization was significantly longer in group M than in group S. About 44 patients in group M with additional 58 nodules without localization had undergone direct surgical resection simultaneously, and bilateral surgery was performed in 13 patients (29.5%). The intrathoracic recurrence rate was 4.8% during follow-up CT. Conclusion: Single-stage surgery via an approach of single hookwire localization combined with VATS is feasible and safe for SMPNs.
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Affiliation(s)
- Xianglan Jin
- Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tiegong Wang
- Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Luguang Chen
- Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Pengyi Xing
- Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Xiaoyun Wu
- Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chengwei Shao
- Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Bingding Huang
- College of Big Data and Internet, 507738Shenzhen Technology University, Shenzhen, China
| | - Wangfu Zang
- Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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14
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Zhang Z, Su T, Yu J, Cao S, Wang T, Yang S, Han Y, Wang H, Lu H, Tan Y, Jin L. Modified microcoil for preoperative localization of solitary pulmonary nodules: a prospective, single-arm, multicenter clinical study. J Vasc Interv Radiol 2021; 32:1470-1477.e1. [PMID: 34352362 DOI: 10.1016/j.jvir.2021.06.026] [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: 03/05/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of placement of a modified microcoil for precise preoperative localization of solitary pulmonary nodules (SPNs) before video-assisted thoracoscopic surgery(VATS). MATERIALS AND METHODS This prospective single-arm multicenter study included patients who underwent computed tomography (CT)-guided modified microcoil insertion prior to SPN resection by VATS between January 2018 and June 2018. The patient demographics, nodule characteristics and histopathologic findings were recorded. The primary endpoints included efficacy and safety. RESULTS A total of 96 patients (41 males and 55 females; mean age: 59.3 ± 8.9 years) with 96 SPNs were eligible for enrolment in the study. The mean maximal transverse diameter of the nodules was 10.3 ± 5.2 mm (range: 8-20 mm). The mean time between CT-guided microcoil insertion and the start of the surgical procedure was 14.6 hours (range: 12-24 hours). The duration of the preoperative CT-guided microcoil localization procedure was 29 ± 9 minutes (range: 10-35 minutes), and the intraoperative fluoroscopy time was 0.7 ± 0.7 minutes (range: 0.5-3 minutes). The clinical success rate was 96.9%(93/96), and all nodules were successfully resected using VATS. One patient experienced asymptomatic pneumothorax, but there were no cases of pulmonary hemorrhage. CONCLUSIONS SPN localization with the modified microcoil is feasible and safe. The modified microcoil can facilitate the thoracoscopic resection of SPNs.
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Affiliation(s)
- Zhiyuan Zhang
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, China
| | - Tianhao Su
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, China
| | - Jianan Yu
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, China
| | - Shasha Cao
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, China
| | - Tong Wang
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, China
| | - Siwei Yang
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, China
| | - Yanjing Han
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, China
| | - Haochen Wang
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, China
| | - Haimin Lu
- Department of Thoracic surgery, Nantong Tumor Hospital, Nantong, China
| | - Yulin Tan
- Department of Interventional Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Long Jin
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, China.
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15
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Ye W, Dong C, Lin C, Wu Q, Li J, Zhou Z, Wen M, Liang C, Zhao Z, Yang L. Medical adhesive vs hookwire for computed tomography-guided preoperative localization and risk factors of major complications. Br J Radiol 2021; 94:20201208. [PMID: 34319810 DOI: 10.1259/bjr.20201208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To compare the efficacy of medical adhesive and hookwire as CT-guided non-palpable pulmonary nodule (NPN) localization methods before video-assisted thoracoscopic surgery (VATS) resection, and determine the risk factors for common complications during localization. METHODS This was a single-center non-randomized retrospective study. 102 consecutive patients with 109 NPNs were divided into Group A (medical adhesive, 66 patients, 72 nodules) and Group B (hookwire, 36 patients, 37 nodules) before VATS. Patient- and nodule-based characteristics were compared. Logistic regression was performed to identify the risk factors for complications. RESULTS Localization was successfully performed in all the NPNs. For Group A, the rate of pneumothorax immediately after localization was lower (p = 0.049) and the localization-to-surgery interval was longer (p = 0.011) than Group B. There was no significant difference in rates of hemorrhage after needle withdrawal between the two groups (p = 0.198). Hookwire ( vs medical adhesive) (β = 1.12, p = 0.018), total insertion depth (β = -0.41, p = 0.013), pleura-needle angle (β = -0.04, p = 0.025) and grade of hemorrhage after needle withdrawal (β = -0.96, p = 0.030) were independently associated with pneumothorax, while age (β = -0.94, p = 0.018), tumor size (β = 0.29, p = 0.007) and its distance from the pleural surface (β = 0.14, p = 0.004) were associated with higher grade hemorrhage after needle withdrawal. CONCLUSION Compared with hookwire, localization with medical adhesive excelled in lower risk of pneumothorax, a more flexible localization-to-surgery interval, and had similar rates of hemorrhage after needle withdrawal. Hookwire is an independent risk factor of pneumothorax immediately after localization. ADVANCES IN KNOWLEDGE This study added new clinical evidence to the efficacy of medical adhesive in pre-operative CT-guided NPN localization.
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Affiliation(s)
- Weitao Ye
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Chenyu Dong
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Churong Lin
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Qidi Wu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jiao Li
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Zihao Zhou
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Menghuang Wen
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Changhong Liang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Zhenjun Zhao
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Lin Yang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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16
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Fu R, Zhang C, Zhang T, Chu XP, Tang WF, Yang XN, Huang MP, Zhuang J, Wu YL, Zhong WZ. A three-dimensional printing navigational template combined with mixed reality technique for localizing pulmonary nodules. Interact Cardiovasc Thorac Surg 2021; 32:552-559. [PMID: 33751118 PMCID: PMC8923295 DOI: 10.1093/icvts/ivaa300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Localizing non-palpable pulmonary nodules is challenging for thoracic surgeons. Here, we investigated the accuracy of three-dimensional (3D) printing technology combined with mixed reality (MR) for localizing ground glass opacity-dominant pulmonary nodules. METHODS In this single-arm study, we prospectively enrolled patients with small pulmonary nodules (<2 cm) that required accurate localization. A 3D-printing physical navigational template was designed based on the reconstruction of computed tomography images, and a 3D model was generated through the MR glasses. We set the deviation distance as the primary end point for efficacy evaluation. Clinicopathological and surgical data were obtained for further analysis. RESULTS Sixteen patients with 17 non-palpable pulmonary nodules were enrolled in this study. Sixteen nodules were localized successfully (16/17; 94.1%) using this novel approach with a median deviation of 9 mm. The mean time required for localization was 25 ± 5.2 min. For the nodules in the upper/middle and lower lobes, the median deviation was 6 mm (range, 0-12.0) and 16 mm (range, 15.0-20.0), respectively. The deviation difference between the groups was significant (Z = -2.957, P = 0.003). The pathological evaluation of resection margins was negative. CONCLUSIONS The 3D printing navigational template combined with MR can be a feasible approach for localizing pulmonary nodules.
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Affiliation(s)
- Rui Fu
- Guangdong Lung Cancer Institute, Guangdong
Provincial People’s Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, China
- Shantou University Medical College,
Shantou, China
| | - Chao Zhang
- Guangdong Lung Cancer Institute, Guangdong
Provincial People’s Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, China
| | - Tao Zhang
- Guangdong Lung Cancer Institute, Guangdong
Provincial People’s Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, China
- Shantou University Medical College,
Shantou, China
| | - Xiang-Peng Chu
- Guangdong Lung Cancer Institute, Guangdong
Provincial People’s Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, China
| | - Wen-Fang Tang
- Guangdong Lung Cancer Institute, Guangdong
Provincial People’s Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, China
- Shantou University Medical College,
Shantou, China
| | - Xue-Ning Yang
- Guangdong Lung Cancer Institute, Guangdong
Provincial People’s Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, China
| | - Mei-Ping Huang
- Department of Catheterization Lab, Guangdong
Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China
Structural Heart Disease, Guangdong Provincial People's Hospital,
Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiac Surgery, Guangdong
Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China
Structural Heart Disease, Guangdong Provincial People's Hospital,
Guangdong Academy of Medical Sciences, School of Medicine, South China
University of Technology, Guangzhou, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong
Provincial People’s Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, China
| | - Wen-Zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong
Provincial People’s Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, China
- Corresponding author. Guangdong Lung Cancer Institute,
Guangdong Provincial People’s Hospital, Guangdong Academy of Medical
Sciences, Guangzhou 510080, China. Tel: +86-20-83877855; fax:
+86-20-83844620; e-mail: (W.-Z.
Zhong)
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17
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Ultrasound-Guided Hook-Wire Localization for Surgical Excision of Non-Palpable Superficial Inguinal Lymph Nodes in Dogs: A Pilot Study. Animals (Basel) 2020; 10:ani10122314. [PMID: 33297352 PMCID: PMC7762221 DOI: 10.3390/ani10122314] [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: 11/12/2020] [Accepted: 12/02/2020] [Indexed: 11/17/2022] Open
Abstract
The evaluation of loco-regional lymph nodes (LN) plays an important prognostic role and assists the clinical decision making in canine cancer patients. Excision of non-palpable LN can be challenging. The aim of the study was to evaluate surgical time, successful excision rate and surgical complications associated with the use of an ultrasound-guided hook-wire (UGHW) LN localization method for non-palpable superficial inguinal LN (SILN) in dogs. Dogs that presented for excision of non-palpable SILN, performed with the aid of an UGHW placement, were enrolled. Information including signalment, SILN width, UGHW placement and surgical procedure time, hook-wire position, successful excision and intra- and post-operative complications were reviewed. Seventeen dogs were enrolled. Median LN width was 3 mm (range 2-11). Median time of preoperative UGHW placement and surgical LN excision was 8 min and 15 min, respectively. Successful SILN excision was achieved in all cases. Two minor intra-operative (hook migration and wire fragmentation) and one minor post-operative complications (seroma) were observed. No major intraoperative or post-operative complications occurred. The UGHW LN localization method is safe and effective and may allow a high rate of successful SILN excisions in dogs. This method has the potential to facilitate LN excision for other superficial LN locations.
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18
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Fu R, Chai YF, Zhang JT, Zhang T, Chen XK, Dong S, Yan HH, Yang XN, Huang MP, Wu YL, Zhuang J, Zhong WZ. Three-dimensional printed navigational template for localizing small pulmonary nodules: A case-controlled study. Thorac Cancer 2020; 11:2690-2697. [PMID: 32686309 PMCID: PMC7471015 DOI: 10.1111/1759-7714.13550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/03/2022] Open
Abstract
Background Localization of small pulmonary nodules is an inevitable challenge for the thoracic surgeon. This study aimed to investigate the accuracy of three‐dimensional (3D) printing technology for localizing small pulmonary nodules, especially ground‐glass nodules (GGNs). Methods This study enrolled patients with peripheral small pulmonary nodules (≤ 2 cm) who required preoperative localization. In the comparison period, patients underwent both computed tomography‐guided (CT‐G) and 3D‐printing template guided (3D‐G) localization to compare the accuracies of the two methods. In the testing period, the 3D‐printing technique was implemented alone. The 3D‐printing physical navigational template was designed based on data from perioperative CT images. Clinical data, imaging data, surgical data, and evaluation index were collected for further analysis. The learning curve of the 3D‐printing localization technique was assessed using cumulative sum (CUSUM) analysis and multiple linear regression analysis. Results In the comparison period (n = 14), the success rates of CT‐G and 3D‐G were 100% and 92.9% (P = 0.31), respectively; in the testing period (n = 23), the success rate of 3D‐G was 95.6%. The localization times of CT‐G, 3D‐G (comparison), and 3D‐G (testing) were 23.6 ± 5.3, 19.3 ± 6.8, and 9.8 ± 4.6 minutes, respectively. The CUSUM learning curve was modeled using the equation: Y = 0.48X2− 0.013X − 0.454 (R2 = 0.89). The learning curve was composed of two phases, phase 1 (the initial 20 patients) and phase 2 (the remaining 17 patients). Conclusions 3D printing localization has adequate accuracy and is a feasible and accessible strategy for use in localizing small pulmonary nodules, especially in right upper lobe. The use of this technique could facilitate lung nodule localization prior to surgery.
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Affiliation(s)
- Rui Fu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yun-Fei Chai
- Anesthesiology Department of Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jia-Tao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiao-Kun Chen
- 3D Printing Joint Laboratory of Cardiovascular Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Song Dong
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hong-Hong Yan
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xue-Ning Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mei-Ping Huang
- Department of Catheterization Lab, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wen-Zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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19
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Lee JW, Park CH, Lee SM, Jeong M, Hur J. Planting Seeds into the Lung: Image-Guided Percutaneous Localization to Guide Minimally Invasive Thoracic Surgery. Korean J Radiol 2020; 20:1498-1514. [PMID: 31606955 PMCID: PMC6791818 DOI: 10.3348/kjr.2019.0155] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/18/2019] [Indexed: 12/18/2022] Open
Abstract
Image-guided localization materials are constantly evolving, providing options for the localization of small pulmonary nodules to guide minimally invasive thoracic surgery. Several preoperative methods have been developed to localize small pulmonary lesions prior to video-assisted thoracic surgery. These localization techniques can be categorized into 4 groups according to the materials used: localization with metallic materials (hook-wire, microcoil, or spiral coil), localization with dye (methylene blue or indigo carmine), localization with contrast agents (lipiodol, barium, or iodine contrast agents), and radiotracers (technetium-99m). However, the optimal localization method has not yet been established. In this review article, we discuss the various localization techniques and the advantages and disadvantages of localization techniques as well as the available safety and efficacy data on these techniques.
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Affiliation(s)
- Ji Won Lee
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Min Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Miri Jeong
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Jin Hur
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Yanagiya M, Kawahara T, Ueda K, Yoshida D, Yamaguchi H, Sato M. A meta-analysis of preoperative bronchoscopic marking for pulmonary nodules. Eur J Cardiothorac Surg 2020; 58:40-50. [DOI: 10.1093/ejcts/ezaa050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/18/2020] [Accepted: 01/24/2020] [Indexed: 02/01/2023] Open
Abstract
Abstract
OBJECTIVES
Recent studies have suggested the usefulness of preoperative bronchoscopic marking techniques for the localization of pulmonary nodules in thoracic surgery. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of preoperative bronchoscopic marking.
METHODS
The PubMed and Cochrane Library databases were searched for clinical studies evaluating preoperative bronchoscopic marking for pulmonary resection. Non-comparative and random effects model-based meta-analyses were conducted to calculate the pooled success and complication rates of bronchoscopic marking.
RESULTS
Twenty-five eligible studies were included. Among these, 15 studies conducted dye marking under electromagnetic navigation bronchoscopy, 4 used virtual-assisted lung mapping and 7 used other marking methods. The overall pooled successful marking rate, successful resection rate and complete resection rate were 0.97 [95% confidence interval (CI) 0.95–0.99], 0.98 (95% CI 0.96–1.00) and 1.00 (95% CI 1.00–1.00), respectively. The overall pooled rates of pleural injury and pulmonary haemorrhage were 0.02 (95% CI 0.01–0.05) and 0.00 (95% CI 0.00–0.00), respectively.
CONCLUSIONS
This meta-analysis demonstrated that bronchoscopic marking is very safe and effective. Bronchoscopic marking should be considered, especially if there are concerns about the safety of other localization methods.
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Affiliation(s)
- Masahiro Yanagiya
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Takuya Kawahara
- Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Keiko Ueda
- Management Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Hirokazu Yamaguchi
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Sun SH, Gao J, Zeng XM, Zhang YF. Computed tomography-guided localization for lung nodules: methylene-blue versus coil localization. MINIM INVASIV THER 2020; 30:215-220. [PMID: 32039637 DOI: 10.1080/13645706.2020.1725579] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare the relative clinical efficacy of preoperative computed tomography (CT)-guided methylene-blue (MB) and coil localization for lung nodules (LNs). MATERIAL AND METHODS Between January 2013 and December 2018, a total of 89 patients with LNs underwent CT-guided MB or coil localization and subsequent video-assisted thoracoscopic surgery (VATS)-guided wedge resection in our hospital. We compared the technical success of localization and wedge resection between two groups. RESULTS In MB group, 47 LNs in 39 patients were localized, with successful localization and wedge resection rates of 97.9% and 97.9%, respectively. In the coil group, 64 LNs in 50 patients were localized, with successful localization and wedge resection rates of 96.9% and 96.9%, respectively. There were no significant differences in technical success rates of localization and wedge resection between the two groups (p = 1.000 and 1.000). The coil group sustained a longer duration between localization and VATS relative to the MB group (14.4 h vs. 1.6 h, p = .001). CONCLUSION Both MB and coil localization were safe and effective techniques to establish a high success rate of VATS-guided wedge resection for LNs. Relative to MB localization, coil localization might be compatible with a longer delay between localization and VATS.
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Affiliation(s)
- Shi-Hang Sun
- Department of Medical Imaging, Yidu Central Hospital, Weifang Medical University, Qingzhou, Shandong, China
| | - Jian Gao
- Department of Medical Imaging, Yidu Central Hospital, Weifang Medical University, Qingzhou, Shandong, China
| | - Xiang-Min Zeng
- Department of Medical Imaging, Yidu Central Hospital, Weifang Medical University, Qingzhou, Shandong, China
| | - Yun-Feng Zhang
- Department of Interventional Surgery, Yantai Traditional Chinese Medicine Hospital, Yantai, Shandong, China
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Tsai SCS, Wu TC, Lai YL, Lin FCF. Preoperative computed tomography-guided pulmonary nodule localization augmented by laser angle guide assembly. J Thorac Dis 2020; 11:4682-4692. [PMID: 31903257 DOI: 10.21037/jtd.2019.10.60] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background There is an increasing need for thoracic medicine specialists to master preoperative localizations after high rates of sub-centimeter nodules have been positively screened by low-dose CT. The Laser Angle Guide Assembly® (LAGA), an innovative angle reference device for CT-guided pulmonary invasive procedures, has been developed to safely and efficiently aid in the performance of preoperative CT-guided localizations (POCTGL). Methods The clinical and localization data of patients who received LAGA-assisted POCTGL for pulmonary nodules between May 2015 and June 2018 were collected and analyzed. Results One hundred and eighty-seven patients with 266 pulmonary nodules received LAGA-assisted POCTGL. The number of lung nodules localized for one surgery ranged from 1 to 5, with >1 for 22.1% of the surgeries. The median nodule size was 6 mm. A hookwire was inserted in 32 (12%) of the nodules. Most (83.1%) of the localizations were completed with a single puncture. The median angle was 18 degrees. The median and maximum depths of the nodule to pleura were 12 and 60 mm, respectively. The median procedure time was 19 minutes. The successful targeting and field targeting rates were 100% and 98.1%, respectively. Pneumothorax was noted in 17 (6.4%) localizations that did not require chest drainage. The multivariable analyses for pneumothorax showed odds ratios of 2.4 (95% confidence interval, 1.2-4.9) for puncture times/nodule and 10.1 (95% confidence interval, 2.3-41.7) for tumors adjacent to the fissure, respectively. There was no incidence of hookwire migration. Conclusions LAGA enhanced the precision of POCTGL by optimizing targeting precision and decreasing repeated punctures, which minimized complications, such as pneumothorax.
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Affiliation(s)
| | - Tzu-Chin Wu
- Department of Thoracic Medicine, Chung Shan Medical University Hospital, Taichung
| | - Yi-Lin Lai
- Department of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung
| | - Frank Cheau-Feng Lin
- Department of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung.,School of Medicine, Chung Shan Medical University, Taichung
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Zheng B, Xu G, Fu X, Wu W, Liang M, Zeng T, Zhang S, Zhu Y, Zheng W, Chen C, Bédat B, Swanson SJ, Koike T, Iwata H, Bedetti B, Sato M. Management of the inter-segmental plane using the "Combined Dimensional Reduction Method" is safe and viable in uniport video-assisted thoracoscopic pulmonary segmentectomy. Transl Lung Cancer Res 2019; 8:658-666. [PMID: 31737501 DOI: 10.21037/tlcr.2019.09.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The management of the intersegmental plane (ISP) is challenging during uniport video-assisted thoracoscopic (VATS) pulmonary segmentectomy. Staplers and electrocautery have been used extensively in ISP management. However, both of them have their respective drawbacks. Currently, we have provided a revised technique termed as "Combined Dimensional Reduction Method" (CDR method), for managing the ISP with combined application of ultrasonic scalpel and staplers. The study aimed to review the outcomes of patients who underwent uniport VATS segmentectomy with or without the CDR method in our institute and assess the feasibility and safety of the CDR method. Methods From March 2017 to February 2018, 220 patients who underwent uniport VATS segmentectomy were retrospectively reviewed. By using IQQA software, pulmonary structures were reconstructed as three-dimensional (3D) images, making the targeted structures could be identified preoperatively. For the management of the ISP, in the CDR group, we firstly used the ultrasonic scalpel to trim the 3D pulmonary structure along the intersegmental demarcation, making the remaining targeted parenchyma both sufficiently thin enough and located on a 2D plane; thus, enabling easy use of staplers in managing ISP. Whereas, in the non-CDR group, we only use the staplers to manage the ISPs. The clinical characteristics, complications, and postoperative pulmonary functions were compared between the two groups. Results Propensity score analysis generated 2 well-matched pairs of 71 patients in CDR and non-CDR groups. There was no 30-day postoperative death or readmission in either group. The CDR group was significantly associated with the shorter operative time (178.3±35.8 vs. 209.2±28.7 min) (P=0.031) and postoperative stay (4.5±2.3 vs. 5.7±4.2 days) (P=0.041), compared to the non-CDR group. Moreover, no significant difference was observed in blood loss, a period of chest tube drainage, a period of ultrafine tube drainage, and postoperative pulmonary complications between the two groups. Moreover, the recovery rate of postoperative forced expiratory volume in 1 second (FEV1) or vital capacity (VC) at 1 and 3 months after segmentectomy was comparable between them. Conclusions The CDR method could make segmentectomy easier and more accurate, and therefore has the potential to be a viable and effective technique for uniport VATS pulmonary segmentectomy.
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Affiliation(s)
- Bin Zheng
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Guobing Xu
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Xiayu Fu
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Weidong Wu
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Mingqiang Liang
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Taidui Zeng
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Shuliang Zhang
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Yong Zhu
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Wei Zheng
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Chun Chen
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Benoît Bédat
- Thoracic and Endocrine Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Scott J Swanson
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Terumoto Koike
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hisashi Iwata
- Department of General Thoracic Surgery, Center of Respiratory Disease, Gifu University Hospital, Gifu, Japan
| | | | - Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo Hospital, Bunkyo, Tokyo, Japan
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Teng F, Wang ZS, Wu AL, Fu YF, Yang S. Computed tomography-guided coil localization for video-assisted thoracoscopic surgery of sub-solid lung nodules: a retrospective study. ANZ J Surg 2019; 89:E514-E518. [PMID: 31578777 DOI: 10.1111/ans.15450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 05/21/2019] [Accepted: 08/27/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Wedge resection via video-assisted thoracoscopic surgery (VATS) is the best choice for the diagnosis of sub-solid lung nodules. Preoperative localization is utilized to increase the success rate of this procedure. We aimed to evaluate the effectiveness of preoperative coil localization in VATS wedge resection for sub-solid lung nodules. METHODS From October 2015 to August 2018, 42 patients with 55 sub-solid lung nodules underwent computed tomography-guided coil localization with subsequent VATS wedge resection in our centre. Data regarding visible coil rates, technical success of the wedge resection and pathological results were collected and analysed retrospectively. RESULTS A total of 55 sub-solid lung nodules were localized in 42 patients. Thirty-three patients had one nodule and nine patients had multiple nodules. Fifty-two coils (52/55, 94.5%) were visible during the VATS. The mean duration of each coil localization was 14.3 ± 4.8 min (range 7-40 min). Three patients (7%) experienced pneumothorax after coil localization. VATS wedge resection was successfully performed for 53 nodules (53/55, 96.4%). The remaining two nodules were treated directly with lobectomy. The nine patients who had multiple nodules underwent one-stage VATS wedge resection of all nodules. The mean duration of the VATS in the 42 patients was 159.3 ± 83.4 min (range 60-360 min) while the mean blood loss was 119.3 ± 115.3 mL (range 10-700 mL). CONCLUSION Preoperative computed tomography-guided coil localization is a safe and effective method to facilitate high success rates for diagnostic VATS wedge resection for sub-solid nodules.
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Affiliation(s)
- Fei Teng
- Department of Radiology, Ningbo First Hospital, Ningbo, Zhejiang, China
| | - Zi-Shan Wang
- Department of Thoracic Surgery, Ningbo First Hospital, Ningbo, Zhejiang, China
| | - An-Le Wu
- Department of Radiology, Ningbo First Hospital, Ningbo, Zhejiang, China
| | - Yu-Fei Fu
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Shan Yang
- Department of Radiology, Ningbo First Hospital, Ningbo, Zhejiang, China
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Comparison of cyanoacrylate and hookwire for localizing small pulmonary nodules: A propensity-matched cohort study. Int J Surg 2019; 71:49-55. [PMID: 31521836 DOI: 10.1016/j.ijsu.2019.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/19/2019] [Accepted: 09/06/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Localizing small pulmonary nodules (SPNs) is a challenge during thoracoscopic resection, but preoperative computed tomography (CT)-guided localization using either cyanoacrylate or hookwire can be helpful. This study compared the safety, efficiency, and operability of the two techniques. METHODS From September 2013 to November 2018, 269 patients (269 SPNs) who underwent preoperative CT-guided SPN localization were enrolled. A propensity-matched analysis, incorporating 13 variables, was performed to control potential selection bias. RESULTS All the patients were divided into two groups: CT-guided cyanoacrylate localization group (Group C, n = 149) and CT-guided hookwire localization group (Group H, n = 120). Eighty-six patients were propensity-matched in each group. All SPNs were successfully removed thoracoscopically, and no conversion was required. Localization-related complications in the two groups were similar, including intrapulmonary focal hemorrhage (p = 0.823), pneumothorax (p = 1.000), or hemoptysis (p = 0.121). For pain assessment and management, the cyanoacrylate localization saw a lower pain score (p < 0.001) and less morphine use (p < 0.001). In Group H, the localization took a significantly longer time (p < 0.001). Covering only the patients in Group C, the sub-analysis found that cyanoacrylate localization on the day before surgery did not compromise the accuracy of intraoperative targeting or increase the incidence of complications, compared with the localization on the day of surgery (all p > 0.05). CONCLUSION Compared to hookwire localization, CT-guided cyanoacrylate localization decreased pain and morphine use and allowed flexible surgical schedules, suggestive of its preferability for the resection of SPNs.
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Yao F, Yao J, Xu L, Wang J, Gao L, Wang J. Computed tomography-guided cyanoacrylate localization of small pulmonary nodules: feasibility and initial experience. Interact Cardiovasc Thorac Surg 2019; 28:387-393. [PMID: 30247604 DOI: 10.1093/icvts/ivy277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/07/2018] [Accepted: 08/15/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES We report our initial technical experience with computed tomography (CT)-guided cyanoacrylate localization for resection of small pulmonary nodules (SPNs) and evaluate the feasibility of this technique. METHODS Between June 2016 and December 2017, the diagnostic results of 55 consecutive patients (69 SPNs) who underwent preoperative CT-guided cyanoacrylate localization and consequent video-assisted thoracoscopic surgery (VATS) resection were retrospectively evaluated. Localization-related outcomes and perioperative outcomes were assessed. RESULTS Preoperative CT-guided cyanoacrylate localization was successfully performed in all the cases. Simultaneous localization was achieved in 8 (14.5%) patients with 2 nodules and 3 (5.5%) patients with 3 nodules. The mean size of the nodules was 8.5 ± 3.2 mm (range 5-20 mm), and their mean depth from the nearest pleural surface was 10.9 ± 7.7 mm (range 2-36 mm). The overall mean localization procedural time was 13.7 ± 7.2 min (range 6-37 min). Two localization-related complications (intrapulmonary focal haemorrhage and pneumothorax) were observed in 7 (12.7%) and 12 (21.8%) patients, respectively. All patients with complications were asymptomatic and received conservative treatment only. All SPNs were resected under VATS without any conversion to minithoracotomy or thoracotomy. CONCLUSIONS CT-guided cyanoacrylate localization is a feasible procedure to localize SPNs. The advantages of this technique include flexibility between insertion and excision, the ability to be applied to the whole lung field, a high success rate, patient comfort after insertion and a fast learning curve. Further studies are warranted to confirm the efficacy of this technique.
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Affiliation(s)
- Fei Yao
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ju Yao
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lei Xu
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jian Wang
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Libing Gao
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jian Wang
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Fu YF, Gao YG, Zhang M, Wang T, Shi YB, Huang YY. Computed tomography-guided simultaneous coil localization as a bridge to one-stage surgery for multiple lung nodules: a retrospective study. J Cardiothorac Surg 2019; 14:43. [PMID: 30808426 PMCID: PMC6390604 DOI: 10.1186/s13019-019-0870-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/17/2019] [Indexed: 11/18/2022] Open
Abstract
Background Video-assisted thoracoscopic surgery (VATS) has been widely used for diagnostic wedge resection of lung nodules. When VATS is performed for multiple lung nodules, preoperative localization for each target nodule is required. In this study, we evaluated the clinical effectiveness of computed tomography (CT)-guided simultaneous coil localization in one-stage VATS wedge resection for multiple lung nodules. Methods Between November 2015 to March 2018, 19 patients with multiple target nodules underwent CT-guided simultaneous coil localization and one-stage VATS resection at our center. Data on the technical success of simultaneous localization and wedge resection, complications, and pathological results were collected. Results A total of 43 nodules were localized. The localization was successfully achieved in 42 of 43 nodules (97.7%). The technique of simultaneous localization was successfully achieved in 18 of 19 patients (94.7%). Fifteen patients underwent unilateral lung localization and four patients underwent bilateral lung localization. Three patients (15.8%) experienced asymptomatic pneumothorax after localization. All patients successfully underwent one-stage wedge resection for all target nodules. The mean duration of one-stage VATS procedure was 171.8 ± 84.0 min. The mean volume of blood loss was 94.2 ± 58.0 mL. Three patients experienced pleural effusion after VATS. During a follow-up of 6–31 months (median 18 months), no patient developed new lung nodules or distant metastasis. Conclusions Preoperative simultaneous coil implantation is a safe and simple method for localization of multiple lung nodules. Simultaneous coil localization could effectively guide a one-stage VATS diagnostic wedge resection procedure.
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Affiliation(s)
- Yu-Fei Fu
- Department of Radiology, Xuzhou Central Hospital, 199 Jiefang Road, Xuzhou, Jiangsu, China
| | - Yong-Guang Gao
- Department of Radiology, Xuzhou Central Hospital, 199 Jiefang Road, Xuzhou, Jiangsu, China
| | - Miao Zhang
- Department of Thoracic Surgery, Xuzhou Central Hospital, 199 Jiefang Road, Xuzhou, Jiangsu, China
| | - Tao Wang
- Department of Radiology, Xuzhou Central Hospital, 199 Jiefang Road, Xuzhou, Jiangsu, China
| | - Yi-Bing Shi
- Department of Radiology, Xuzhou Central Hospital, 199 Jiefang Road, Xuzhou, Jiangsu, China
| | - Ya-Yong Huang
- Department of Radiology, Xuzhou Central Hospital, 199 Jiefang Road, Xuzhou, Jiangsu, China.
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Yang ZJ, Liang YH, Li M, Fang P. Preoperative computed tomography-guided coil localization of lung nodules. MINIM INVASIV THER 2019; 29:28-34. [PMID: 30712417 DOI: 10.1080/13645706.2019.1576053] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To evaluate the usefulness of preoperative computed tomography (CT)-guided coil localization in patients with lung nodules who underwent video-assisted thoracoscopic surgery (VATS) for lung resection.Material and methods: From October 2015 to January 2018, 76 patients with lung nodules underwent CT-guided coil localization and subsequent VATS in our center. The tail of the coil remained above the visceral pleura. Data regarding the technical success of coil localization and wedge resection were analyzed.Results: A total of 96 lung nodules in 76 patients were localized. The technical success rate of CT-guided coil localization was 97.9% (94/96). Among the 94 localized nodules, 88 coils were visible and six coils were palpated during VATS. Nine patients experienced pneumothorax and two patients experienced hemoptysis after coil localization. Two patients underwent VATS beyond 24 h after coil localization. The technical success rate of wedge resection of lung nodules was 97.9%. Seventeen patients with multiple target lung nodules underwent one-stage video-assisted resection of all target nodules after coil localization.Conclusion: Preoperative CT-guided coil localization is a safe and convenient method to facilitate a high success rate of diagnostic VATS wedge-resection of lung nodules. Coil localization can also facilitate one-stage VATS wedge-resection of multiple nodules.
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Affiliation(s)
- Zhong-Jie Yang
- Radiological Department, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou, China
| | - Yong-Hui Liang
- Radiological Department, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou, China
| | - Ming Li
- Radiological Department, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou, China
| | - Peng Fang
- Radiological Department, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou, China
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Shen C, Li P, Li J, Che G. [Advancement of Common Localization of Solitary Pulmonary Nodules
for Video-assisted Thracoscopic Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:628-634. [PMID: 30172271 PMCID: PMC6105347 DOI: 10.3779/j.issn.1009-3419.2018.08.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
最近,伴随着高分辨多层电子计算机断层扫描(computed tomography, CT)的大量普及,肺小结节的诊断也日益增多,尤其是在伴有肺癌高危因素的患者行CT筛查时尤为明显。电视辅助胸腔镜手术对于肺小结节的诊断和治疗提供了一种全新的微创治疗方式,胸腔镜手术后给患者带来的疼痛感减少、住院时间缩短、手术并发症减少等特点,使其推广更为广泛。如何精准定位及标记病灶,以助电视胸腔镜下切除病灶的方法层出不穷。本文综述近年来胸腔镜下肺小结节定位的各种技术手段,并对各种方法的利弊进行总结及分析。
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Affiliation(s)
- Cheng Shen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Pengfei Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jue Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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