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Natale G, Leonardi B, Messina G, Bergameo G, Di Filippo V, Chisari G, Raciti G, Lombardo SP, Mirra R, Capasso F, Leone F, Pica DG, Fiorelli A. Three-dimensional lung reconstructions for the localization of lung nodules to be resected during surgery. Thorac Cancer 2023; 14:3389-3396. [PMID: 37860943 PMCID: PMC10693940 DOI: 10.1111/1759-7714.15131] [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: 09/05/2023] [Revised: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND The localization of lung nodules is challenging during thoracoscopy. In this study, we evaluated the use of three-dimensional (3D) lung reconstruction for use in the operating room to guide the identification of lung nodules during thoracoscopy. METHODS This was a single-center retrospective study. All consecutive patients undergoing thoracoscopic resection of lung nodules were included in the study. Patients were retrospectively divided into two groups based upon whether the thoracoscopic resection was performed with the assistance (3D group) or not (standard group) of 3D lung reconstruction. The operative time (minutes) to detect lung nodules was statistically compared between the two study groups in relation to the characteristics of lung nodules as size, localization, and distance from the visceral pleura. RESULTS Our study population consisted of 170 patients: 85 in the 3D group and 85 in the standard group. No intergroup difference differences were found regarding the characteristics and histological diagnosis of lesions. The standard group compared to the 3D group was associated with a significantly longer operative time for the detection of lesions <10 mm (13.87 ± 2.59 vs. 5.52 ± 1.01, p < 0.001), lesions between 10 and 20 mm (5.05 ± 0.84 vs. 3.89 ± 0.92; p = 0.03), lesions localized in complex segments (7.49 ± 4.25 vs. 5.11 ± 0.97; p < 0.001), and deep lesions (9.58 ± 4.82 vs. 5.4 ± 1.01, p < 0.001). CONCLUSIONS Our 3D lung reconstruction model for use in the operating room may be an additional tool for thoracic surgeons to guide the detection of small and deep nodules during thoracoscopy. It is a noninvasive and cost saving procedure and may be widely used.
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Affiliation(s)
- Giovanni Natale
- Thoracic Surgery Unit, Department of Translation MedicineUniversità della Campania “LuigiVanvitelli”NaplesItaly
| | - Beatrice Leonardi
- Thoracic Surgery Unit, Department of Translation MedicineUniversità della Campania “LuigiVanvitelli”NaplesItaly
| | - Gaetana Messina
- Thoracic Surgery Unit, Department of Translation MedicineUniversità della Campania “LuigiVanvitelli”NaplesItaly
| | - Grazia Bergameo
- Thoracic Surgery Unit, Department of Translation MedicineUniversità della Campania “LuigiVanvitelli”NaplesItaly
| | - Vincenzo Di Filippo
- Thoracic Surgery Unit, Department of Translation MedicineUniversità della Campania “LuigiVanvitelli”NaplesItaly
| | - Giulia Chisari
- Genomics and Experimental Oncology Unit, IOM RicercaViagrandeItaly
| | - Gabriele Raciti
- Genomics and Experimental Oncology Unit, IOM RicercaViagrandeItaly
| | | | - Rosa Mirra
- Thoracic Surgery Unit, Department of Translation MedicineUniversità della Campania “LuigiVanvitelli”NaplesItaly
| | - Francesca Capasso
- Thoracic Surgery Unit, Department of Translation MedicineUniversità della Campania “LuigiVanvitelli”NaplesItaly
| | - Francesco Leone
- Thoracic Surgery Unit, Department of Translation MedicineUniversità della Campania “LuigiVanvitelli”NaplesItaly
| | - Davide Gerardo Pica
- Thoracic Surgery Unit, Department of Translation MedicineUniversità della Campania “LuigiVanvitelli”NaplesItaly
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Department of Translation MedicineUniversità della Campania “LuigiVanvitelli”NaplesItaly
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Cardillo G, Petersen RH, Ricciardi S, Patel A, Lodhia JV, Gooseman MR, Brunelli A, Dunning J, Fang W, Gossot D, Licht PB, Lim E, Roessner ED, Scarci M, Milojevic M. European guidelines for the surgical management of pure ground-glass opacities and part-solid nodules: Task Force of the European Association of Cardio-Thoracic Surgery and the European Society of Thoracic Surgeons. Eur J Cardiothorac Surg 2023; 64:ezad222. [PMID: 37243746 DOI: 10.1093/ejcts/ezad222] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/10/2023] [Accepted: 05/26/2023] [Indexed: 05/29/2023] Open
Affiliation(s)
- Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Unicamillus-Saint Camillus University of Health Sciences, Rome, Italy
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Sara Ricciardi
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Akshay Patel
- Department of Thoracic Surgery, University Hospitals Birmingham, England, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Joshil V Lodhia
- Department of Thoracic Surgery, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Michael R Gooseman
- Department of Thoracic Surgery, Hull University Teaching Hospitals NHS Trust, and Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Joel Dunning
- James Cook University Hospital Middlesbrough, United Kingdom
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shangai, China
| | - Dominique Gossot
- Department of Thoracic Surgery, Curie-Montsouris Thoracic Institute, Paris, France
| | - Peter B Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Eric Lim
- Academic Division of Thoracic Surgery, The Royal Brompton Hospital and Imperial College London, United Kingdom
| | - Eric Dominic Roessner
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Marco Scarci
- Division of Thoracic Surgery, Imperial College NHS Healthcare Trust and National Heart and Lung Institute, Hammersmith Hospital, London, United Kingdom
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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Chiang H, Chen LK, Hsieh WP, Tang YX, Lo CY. Complications during CT-Guided Lung Nodule Localization: Impact of Needle Insertion Depth and Patient Characteristics. Diagnostics (Basel) 2023; 13:diagnostics13111881. [PMID: 37296733 DOI: 10.3390/diagnostics13111881] [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: 04/21/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Although widely used, CT-guided lung nodule localization is associated with a significant risk of complications, including pneumothorax and pulmonary hemorrhage. This study identified potential risk factors affecting the complications associated with CT-guided lung nodule localization. Data from patients with lung nodules who underwent preoperative CT-guided localization with patent blue vital (PBV) dye at Shin Kong Wu Ho-Su Memorial Hospital, Taiwan, were retrospectively collected. Logistic regression analysis, the chi-square test, and the Mann-Whitney test were used to analyze the potential risk factors for procedure-related complications. We included 101 patients with a single nodule (49 with pneumothorax and 28 with pulmonary hemorrhage). The results revealed that men were more susceptible to pneumothorax during CT-guided localization (odds ratio: 2.48, p = 0.04). Both deeper needle insertion depth (odds ratio: 1.84, p = 0.02) and nodules localized in the left lung lobe (odds ratio: 4.19, p = 0.03) were associated with an increased risk of pulmonary hemorrhage during CT-guided localization. In conclusion, for patients with a single nodule, considering the needle insertion depth and patient characteristics during CT-guided localization procedures is probably important for reducing the risk of complications.
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Affiliation(s)
- Hua Chiang
- Department of Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan
| | - Liang-Kuang Chen
- Department of Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan
| | - Wen-Pei Hsieh
- Department of Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan
| | - Yun-Xuan Tang
- Department of Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu 30015, Taiwan
| | - Chun-Yu Lo
- Department of Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan
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Implementation of sodium alginate-Fe 3O 4 to localize undiagnosed small pulmonary nodules for surgical management in a preclinical rabbit model. Sci Rep 2022; 12:9979. [PMID: 35705647 PMCID: PMC9200847 DOI: 10.1038/s41598-022-13884-w] [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: 02/10/2022] [Accepted: 05/30/2022] [Indexed: 11/08/2022] Open
Abstract
Many methods are used to locate preoperative small pulmonary nodules. However, deficiencies of complications and success rates exist. We introduce a novel magnetic gel for small pulmonary nodules localization in rabbit model, and furtherly evaluate its safety and feasibility. Rabbits were used as the experimental objects. A magnetic gel was used as a tracer magnet, mixed as sodium alginate-Fe3O4 magnetic fluid and calcium gluconate solution. In short-term localization, a coaxial double-cavity puncture needle was applied to inject the gel into the lung after thoracotomy, and a pursuit magnet made of Nd-Fe-B permanent magnetic materials was used to attract the gel representing location of the nodule. In long-term localization, the gel was injected under X-ray guidance. Imaging changes to the lung were observed under X-ray daily. Thoracotomy was performed to excise tissue containing the gel, and hematoxylin-eosin staining was used to observe the tissue on postoperative days 1, 3, 5, and 7. Observe tissues morphology of heart, liver, spleen, and kidney in the same way. The gel was formed after injection and drew lung tissue to form a protrusion from the lung surface under the applied magnetic field. No complication was observed. The shape and position of the gel had not changed when viewed under X-ray. Pathological analysis showed the gel had a clear boundary without diffusion of magnetic fluid. All tissues retained good histologic morphology and no magnetic fluid was observed. Our study preliminarily suggested that the technique using sodium alginate-Fe3O4 magnetic gel to locate small pulmonary nodules with guidance of X-ray, and to search for them under an applied magnetic field during the operation is safe and feasible.
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Wang ML, Hung MH, Hsu HH, Cheng YJ, Chen JS. Non-intubated Thoracoscopic Surgery to Minimize Contamination From Airway Secretions During the COVID-19 Pandemic. Front Surg 2022; 9:818824. [PMID: 35252335 PMCID: PMC8894440 DOI: 10.3389/fsurg.2022.818824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/27/2022] [Indexed: 01/08/2023] Open
Abstract
Background General anesthesia and tracheal intubation potentially pose a high risk to health care workers (HCWs) managing surgical patients during the coronavirus disease 2019 (COVID-19) pandemic. Non-intubated anesthesia is a rational way of managing patients undergoing thoracoscopic surgery that avoids tracheal intubation and minimizes the aerosols generated during airway instrumentation. The purpose of this study was to determine whether non-intubated anesthesia in combination with a face mask is safe and feasible in patients undergoing thoracoscopic surgery. Methods A total of 18 patients who underwent non-intubated thoracoscopic surgery with a face mask during the perioperative period between March 9, 2020 and April 6, 2020 were included. The main outcomes were anesthetic management and postoperative results. Results The 18 patients had a mean age of 64 years and a body mass index of 22.9 kg/m2. All patients wore a mask during induction of anesthesia and throughout surgery. Three patients underwent lobectomy, four segmentectomy, ten wedge resection, and one underwent anterior mediastinal tumor resection. No patient developed cough or vomiting during the perioperative period. All patients were transferred to the postoperative recovery unit within 15 min of the end of surgery (average 7.2 min). No patient required conversion to tracheal intubation or conversion to thoracotomy. Conclusion Non-intubated anesthesia with a mask was safe and feasible in patients undergoing thoracoscopic surgery. Avoidance of intubated general anesthesia and use of a lung separation device may reduce the risk to HCWs of contamination by airway secretions, thereby conserving personal protective equipment, especially during the COVID-19 pandemic.
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Affiliation(s)
- Man-Ling Wang
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Hui Hung
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Anesthesiology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- *Correspondence: Jin-Shing Chen
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Feng Y, Chen CL, Chang YJ, Li YH, Chiou CS, Su LH, Li HC, Yang HP, Chiu CH. Microbiological and genomic investigations of invasive Salmonella enterica serovar Panama from a large outbreak in Taiwan. J Formos Med Assoc 2021; 121:660-669. [PMID: 34294499 DOI: 10.1016/j.jfma.2021.07.002] [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: 02/03/2021] [Revised: 04/26/2021] [Accepted: 07/03/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/PURPOSE Salmonella Panama was considered an invasive non-typhoidal Salmonella (iNTS) serovar. Comprehensive clinical, microbiological, and genomic studies on S. Panama are scarce. We aimed to characterize the clinical and microbiological characteristics of S. Panama infection. Virulence mechanism of S. Panama and other iNTS serovars were also examined. METHODS Based on data from the longitudinal surveillance system for Salmonella deployed in Taiwan since 2004, a case-control study was undertaken to evaluate clinical characteristics of S. Panama infection during an outbreak in 2015-2016. Cellular experiments were conducted to compare pathogenicity of S. Panama and other iNTS with S. Typhimurium. RESULTS Most patients (41/44, 93.2%) infected by S. Panama were <5 years old (median, 1.3 years). The case-control study showed that 28 out of the 41 (68.3%) manifested as bacteremia, compared to S. Typhimurium (11.1%). Patients infected by S. Panama had longer durations of fever (P = 0.005) and hospitalization (P < 0.001). Genomic analyses split the isolates into three clades: two clones caused the outbreak, whereas another one accounted for the sporadic infections before 2015. Cellular experiments revealed that S. Panama and other iNTS serovars showed higher monolayer penetration and intracellular survival within macrophages, compared to S. Typhimurium. CONCLUSION This study confirmed that S. Panama is a clinically invasive serovar. Different iNTS serovars express common virulence phenotypes, but they may acquire invasiveness through distinct expression or combinations of virulence genes.
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Affiliation(s)
- Ye Feng
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China; Institute for Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Chyi-Liang Chen
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yi-Jung Chang
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yi-Hua Li
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chien-Shun Chiou
- Center for Research, Diagnostics and Vaccine Development, Taiwan Centers for Disease Control, Taichung, Taiwan
| | - Lin-Hui Su
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsin-Chieh Li
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsin-Ping Yang
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Wang ML, How CH, Hung MH, Huang HH, Hsu HH, Cheng YJ, Chen JS. Long-term outcomes after nonintubated versus intubated thoracoscopic lobectomy for clinical stage I non-small cell lung cancer: A propensity-matched analysis. J Formos Med Assoc 2021; 120:1949-1956. [PMID: 33994233 DOI: 10.1016/j.jfma.2021.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/08/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Nonintubated thoracoscopic lobectomy has been described as a feasible surgical treatment for early-stage lung cancer since 2011. Despite promising perioperative results, studies on tumor recurrence and long-term survival are very limited. This study was aimed to compare outcomes after thoracoscopic lobectomy with versus without intubation for stage I non-small cell lung cancer. METHODS A retrospective data set including 115 and 155 patients who underwent nonintubated and intubated thoracoscopic lobectomy, respectively, between January 2011 and December 2013 was used to identify matched nonintubated and intubated cohorts (n = 97 per group) using a propensity score matching algorithm that accounted for confounding effects of preoperative patient variables. Primary outcome variables included freedom from recurrence and overall survival. Factors affecting survival were assessed using Cox regression analysis and Kaplan-Meier survival estimates. RESULTS No perioperative mortality occurred in both groups. At an average follow-up of 74 months, comparing nonintubated thoracoscopic lobectomy with intubated procedure, no differences were observed in recurrence rates (14.4% vs. 25.8%, respectively; p = .057). Furthermore, no significant differences were noted in overall survival (97.9% vs. 93.8%, respectively; p = .144). Nonintubated thoracoscopic lobectomy was not found to be an independent predictor of recurrence (hazard ratio, .53; 95% confidence interval [CI], .28-1.02) or overall survival (hazard ratio, .33; 95% CI, .07-1.61). CONCLUSIONS In this propensity-matched comparison, nonintubated thoracoscopic lobectomy was not associated with an increased risk for recurrence and overall survival during the 5-year follow-up. However, more randomized trials should be conducted for further validation of these results.
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Affiliation(s)
- Man-Ling Wang
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Hung How
- Division of Thoracic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ming-Hui Hung
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hui-Hsun Huang
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Anesthesiology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Surgical Oncology, National Taiwan University Cancer Center, Taiwan.
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Lin CY, Chang CC, Huang LT, Chung TJ, Liu YS, Yen YT, Tseng YL. Computed Tomography-Guided Methylene Blue Localization: Single vs. Multiple Lung Nodules. Front Med (Lausanne) 2021; 8:661956. [PMID: 33937298 PMCID: PMC8079624 DOI: 10.3389/fmed.2021.661956] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/17/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Preoperative localization for small invisible and impalpable pulmonary nodules is important in single-port video-assisted thoracoscopic surgery (VATS). Localization of multiple pulmonary nodules during VATS resection remains challenging. The aim of our study is to elucidate the efficacy of preoperative CT-guided methylene blue localization of both single and multiple pulmonary nodules. Methods: Consecutive patients undergoing preoperative CT-guided methylene blue dye localization for lung nodules, followed by VATS resection, were retrospectively analyzed between January 2014 and November 2019. Chi-square tests, Fisher's exact test and independent T-test were used to compare variables between the groups. Logistic regression was used to identify risk factors for procedure-related complications. Results: A total of 388 patients, including 337 with single nodule and 51 with multiple nodules, were analyzed. The success rate of preoperative CT-guided methylene blue localization for both single and multiple pulmonary nodules were comparable as 98.8% (333/337) vs. 100% (108/108). The procedure time was longer (23.2 ± 9.4 vs. 7.6 ± 4.8 min, p < 0.001) and risk of pneumothorax was higher (47.1 vs. 25.5%, p = 0.002) in the multiple nodule group. The procedure time (OR 1.079; 95% CI = 1.041–1.118; p < 0.001) was an independent risk factor for pneumothorax. Nodule depth (OR 2.829; 95% CI = 1.259–6.356; p = 0.011) was an independent risk factor for pulmonary hemorrhage. Conclusions: Preoperative CT-guided methylene blue localization for both single and multiple pulmonary nodules is safe, feasible, and effective.
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Affiliation(s)
- Chia-Ying Lin
- Department of Medical Imaging, College of Medical College, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, College of Medical College, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Li-Ting Huang
- Department of Medical Imaging, College of Medical College, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Ta-Jung Chung
- Department of Medical Imaging, College of Medical College, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Sheng Liu
- Department of Medical Imaging, College of Medical College, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, College of Medical College, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.,Division of Trauma and Acute Care Surgery, Department of Surgery, College of Medical College, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, College of Medical College, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
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Liu HY, Chiang XH, Hung MH, Wang ML, Lin MW, Cheng YJ, Hsu HH, Chen JS. Nonintubated uniportal thoracoscopic segmentectomy for lung cancer. J Formos Med Assoc 2020; 119:1396-1404. [DOI: 10.1016/j.jfma.2020.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 02/25/2020] [Accepted: 03/23/2020] [Indexed: 11/16/2022] Open
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Tsai TM, Chiang XH, Liao HC, Tsou KC, Lin MW, Chen KC, Hsu HH, Chen JS. Computed tomography-guided dye localization for deeply situated pulmonary nodules in thoracoscopic surgery. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:31. [PMID: 30854384 DOI: 10.21037/atm.2019.01.29] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Increased lung cancer screening of asymptomatic adults using low-dose computed tomography (CT) with high-resolution imaging modalities has increased the identification of small and deeply situated pulmonary nodules. This study aimed to evaluate the role of preoperative patient blue vital (PBV) dye localization for an undiagnosed nodule deeply situated in the lung parenchyma followed by minimally invasive lung resection. Methods From July 2013 to December 2016, 27 consecutive patients (16 women, median age: 62 years) with small undiagnosed pulmonary nodules at a depth of more than 30 mm underwent preoperative CT-guided PBV dye localization followed by thoracoscopic diagnostic resection of the nodule at National Taiwan University Hospital. The clinical characteristics were collected retrospectively to evaluate the efficacy and safety of the procedure. Results The median size of pulmonary nodule in preoperative CT images was 11 mm with a median depth of 31.6 mm (range, 30.0-48.6 mm). Of the 27 nodules, 8 were pure ground-glass nodules, 3 were pure solid nodules, and 16 were partially solid nodules. The diagnostic yield of CT-guided dye localization following diagnostic wedge resection was 100%. The final pathological diagnoses were: primary adenocarcinoma of the lung (n=20), adenocarcinoma in situ (n=1), and benign nodules (n=6). Only asymptomatic complications were noted after localization, and the median hospital stay was 3 days [interquartile range (IQR), 3-4 days]. All of 21 patients were cancer-free after a median follow-up of 39.0 months (IQR, 29.5-50.0 months). Conclusions This study indicated that preoperative, percutaneous CT-guided PBV dye localization for undiagnosed nodules at a depth of more than 30 mm could be a safe and feasible procedure. Furthermore, it was considerably advantageous for preserving the lung parenchyma, especially for benign nodules.
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Affiliation(s)
- Tung-Ming Tsai
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Xu-Heng Chiang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsien-Chi Liao
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ke-Cheng Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Chen JR, Tseng YH, Lin MW, Chen HM, Chen YC, Chen MC, Lee YF, Chen JS, Chang YC. Safety and efficacy of computed tomography-guided dye localization using patent blue V for single lung nodule for video-assisted thoracoscopic surgery: a retrospective study. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:28. [PMID: 30854381 DOI: 10.21037/atm.2019.01.27] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background For invisible or impalpable lung nodules, video-assisted thoracoscopic surgery (VATS) has some limitations; some preoperative localization has been developed to overcome this limitation. This study aimed to assess the safety and efficacy of preoperative computed tomography (CT)-guided localization with patent blue V dye. Methods In this retrospective study, we examined patients with solitary pulmonary nodule undergoing preoperative CT-guided patent blue V dye localization from 2013 to 2015. We analyzed patients' demographic data, nodular features, and procedures undergone. Results We enrolled 282 patients (282 lung nodules; mean age: 56.6±11.6 years, with female preponderance) in this study. The mean size of nodules was 0.9±0.5 cm, and mean time of localization was 24 min. The leading complications after localization were asymptomatic pneumothorax (48 patients, 17%) and localized pulmonary hemorrhage (51 patients, 18%). Other rare complications included subcutaneous emphysema and hematoma. We noted two cases with intraoperative poor or fail dye localization. Most patients underwent wedge resection (221 patients, 78.4%) and segmentectomy (36 patients, 12.8%), whereas 25 patients underwent lobectomy (8.9%) after the intraoperative frozen histopathological study confirmed malignancy. Furthermore, postoperative hospital stay was 4.8±2.0 days. Few patients experienced postoperative complications such as empyema (n=1), air leakage (n=3), and chylothorax (n=1). Conclusions This study establishes that CT-guided dye localization is a safe and efficient method with rare severe complications and high success rate.
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Affiliation(s)
- Jing-Ru Chen
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taichung, Taiwan
| | - Yao-Hui Tseng
- Department of Medical Imaging, Cardinal Tien Hospital, Taipei, Taiwan
| | - Mong-Wei Lin
- Department of Surgery, National Taipei University Hospital and National Taiwan University College of Medicine, Taichung, Taiwan
| | - Hsin-Ming Chen
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taichung, Taiwan
| | - Yi-Chang Chen
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taichung, Taiwan
| | - Mei-Chi Chen
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taichung, Taiwan
| | - Yee-Fan Lee
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taichung, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taipei University Hospital and National Taiwan University College of Medicine, Taichung, Taiwan
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taichung, Taiwan
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