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Wang Y, Chen E. Advances in the localization of pulmonary nodules: a comprehensive review. J Cardiothorac Surg 2024; 19:396. [PMID: 38937797 PMCID: PMC11209988 DOI: 10.1186/s13019-024-02911-8] [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: 02/22/2024] [Accepted: 06/15/2024] [Indexed: 06/29/2024] Open
Abstract
In recent years, with the widespread use of chest CT, the detection rate of pulmonary nodules has significantly increased (Abtin and Brown, J Clin Oncol 31:1002-8, 2013). Video-assisted thoracoscopic surgery (VATS) is the most commonly used method for suspected malignant nodules. However, for nodules with a diameter less than 1 cm, or located more than 1.5 cm from the pleural edge, especially ground-glass nodules, it is challenging to achieve precise intraoperative localization by manual palpation (Ciriaco et al., Eur J Cardiothorac Surg 25:429-33, 2004). Therefore, preoperative accurate localization of such nodules becomes a necessary condition for precise resection. This article provides a comprehensive review and analysis of the research progress in pulmonary nodule localization, focusing on four major localization techniques: Percutaneous puncture-assisted localization, Bronchoscopic preoperative pulmonary nodule localization, 3D Printing-Assisted Localization, and intraoperative ultrasound-guided pulmonary nodule localization.
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Affiliation(s)
- Yafang Wang
- Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, Medical School of Zhejiang University, Shangcheng District, No. 3 Qingchun East Road, Hangzhou, 310000, China
| | - Enguo Chen
- Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, Medical School of Zhejiang University, Shangcheng District, No. 3 Qingchun East Road, Hangzhou, 310000, China.
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2
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Arensmeyer J, Bedetti B, Schnorr P, Buermann J, Zalepugas D, Schmidt J, Feodorovici P. A System for Mixed-Reality Holographic Overlays of Real-Time Rendered 3D-Reconstructed Imaging Using a Video Pass-through Head-Mounted Display-A Pathway to Future Navigation in Chest Wall Surgery. J Clin Med 2024; 13:2080. [PMID: 38610849 PMCID: PMC11012529 DOI: 10.3390/jcm13072080] [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: 03/15/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Three-dimensional reconstructions of state-of-the-art high-resolution imaging are progressively being used more for preprocedural assessment in thoracic surgery. It is a promising tool that aims to improve patient-specific treatment planning, for example, for minimally invasive or robotic-assisted lung resections. Increasingly available mixed-reality hardware based on video pass-through technology enables the projection of image data as a hologram onto the patient. We describe the novel method of real-time 3D surgical planning in a mixed-reality setting by presenting three representative cases utilizing volume rendering. Materials: A mixed-reality system was set up using a high-performance workstation running a video pass-through-based head-mounted display. Image data from computer tomography were imported and volume-rendered in real-time to be customized through live editing. The image-based hologram was projected onto the patient, highlighting the regions of interest. Results: Three oncological cases were selected to explore the potentials of the mixed-reality system. Two of them presented large tumor masses in the thoracic cavity, while a third case presented an unclear lesion of the chest wall. We aligned real-time rendered 3D holographic image data onto the patient allowing us to investigate the relationship between anatomical structures and their respective body position. Conclusions: The exploration of holographic overlay has proven to be promising in improving preprocedural surgical planning, particularly for complex oncological tasks in the thoracic surgical field. Further studies on outcome-related surgical planning and navigation should therefore be conducted. Ongoing technological progress of extended reality hardware and intelligent software features will most likely enhance applicability and the range of use in surgical fields within the near future.
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Affiliation(s)
- Jan Arensmeyer
- Division of Thoracic Surgery, Department of General, Thoracic and Vascular Surgery, University Hospital Bonn, 53127 Bonn, Germany (P.F.)
- Bonn Surgical Technology Center (BOSTER), University Hospital Bonn, 53227 Bonn, Germany
| | - Benedetta Bedetti
- Division of Thoracic Surgery, Department of General, Thoracic and Vascular Surgery, University Hospital Bonn, 53127 Bonn, Germany (P.F.)
- Department of Thoracic Surgery, Helios Hospital Bonn/Rhein-Sieg, 53123 Bonn, Germany
| | - Philipp Schnorr
- Division of Thoracic Surgery, Department of General, Thoracic and Vascular Surgery, University Hospital Bonn, 53127 Bonn, Germany (P.F.)
- Department of Thoracic Surgery, Helios Hospital Bonn/Rhein-Sieg, 53123 Bonn, Germany
| | - Jens Buermann
- Division of Thoracic Surgery, Department of General, Thoracic and Vascular Surgery, University Hospital Bonn, 53127 Bonn, Germany (P.F.)
- Department of Thoracic Surgery, Helios Hospital Bonn/Rhein-Sieg, 53123 Bonn, Germany
| | - Donatas Zalepugas
- Division of Thoracic Surgery, Department of General, Thoracic and Vascular Surgery, University Hospital Bonn, 53127 Bonn, Germany (P.F.)
- Department of Thoracic Surgery, Helios Hospital Bonn/Rhein-Sieg, 53123 Bonn, Germany
| | - Joachim Schmidt
- Division of Thoracic Surgery, Department of General, Thoracic and Vascular Surgery, University Hospital Bonn, 53127 Bonn, Germany (P.F.)
- Bonn Surgical Technology Center (BOSTER), University Hospital Bonn, 53227 Bonn, Germany
- Department of Thoracic Surgery, Helios Hospital Bonn/Rhein-Sieg, 53123 Bonn, Germany
| | - Philipp Feodorovici
- Division of Thoracic Surgery, Department of General, Thoracic and Vascular Surgery, University Hospital Bonn, 53127 Bonn, Germany (P.F.)
- Bonn Surgical Technology Center (BOSTER), University Hospital Bonn, 53227 Bonn, Germany
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3
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Zhang X, Yang D, Li L, Wang J, Liang S, Li P, Han Z, Wang X, Zhang K. Application of three-dimensional technology in video-assisted thoracoscopic surgery sublobectomy. Front Oncol 2024; 14:1280075. [PMID: 38525423 PMCID: PMC10957557 DOI: 10.3389/fonc.2024.1280075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 02/15/2024] [Indexed: 03/26/2024] Open
Abstract
Background Due to the widespread use of imaging techniques, the detection rate of early-stage lung cancer has increased. Video-assisted thoracoscopic surgery (VATS) sublobectomy has emerged as a prominent alternative to lobectomy, offering advantages like reduced resection range, better preservation of lung function, and enhanced postoperative quality of life. However, sublobectomy is more intricate than lobectomy, necessitating a higher level of surgical proficiency and anatomical understanding. Methods Three electronic databases were searched to capture relevant studies from January 2016 to March 2023, which related to the application of three-dimensional(3D) technology in VATS sublobectomy. Results Currently, clinical departments such as orthopedics, hepatobiliary surgery, and urology have started using 3D technology. This technology is expected to be widely used in thoracic surgery in future. Now 3D technology assists in preoperative planning, intraoperative navigation and doctor-patient communication. Conclusion 3D technologies, instrumental in locating pulmonary nodules and identifying variations in target lung segmental vessels and bronchi, play pivotal roles in VATS sublobectomy, especially in preoperative planning, intraoperative navigation, and doctor-patient communication. The limitations of 3D technology in clinical application are analyzed, and the future direction of existing 3D technology development is prospected.
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Affiliation(s)
- Xinyu Zhang
- Clinical Medical College of Hebei University, Affiliated Hospital of Hebei University, Baoding, China
- Thoracic Surgery Department, Affiliated Hospital of Hebei University Cardiothoracic Surgical Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Di Yang
- Clinical Medical College of Hebei University, Affiliated Hospital of Hebei University, Baoding, China
- Thoracic Surgery Department, Affiliated Hospital of Hebei University Cardiothoracic Surgical Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Linqian Li
- Surgical Department, Affiliated Hospital of Hebei University, Baoding, China
- Basic Research Key Laboratory of General Surgery for Digital Medicine, Baoding, China
- Institute of Life Science and Green Development, Hebei University, Baoding, China
- 3D Image and 3D Printing Center, Affiliated Hospital of Hebei University, Baoding, China
| | - Jianing Wang
- Institute of Life Science and Green Development, Hebei University, Baoding, China
- Imaging Department of Hebei University Affiliated Hospital, Baoding, China
| | - Si Liang
- Basic Research Key Laboratory of General Surgery for Digital Medicine, Baoding, China
- Institute of Life Science and Green Development, Hebei University, Baoding, China
| | - Peng Li
- Basic Research Key Laboratory of General Surgery for Digital Medicine, Baoding, China
- Institute of Life Science and Green Development, Hebei University, Baoding, China
| | - Zhe Han
- Basic Research Key Laboratory of General Surgery for Digital Medicine, Baoding, China
- Institute of Life Science and Green Development, Hebei University, Baoding, China
| | - Xiaodong Wang
- Basic Research Key Laboratory of General Surgery for Digital Medicine, Baoding, China
- Institute of Life Science and Green Development, Hebei University, Baoding, China
| | - Ke Zhang
- Thoracic Surgery Department, Affiliated Hospital of Hebei University Cardiothoracic Surgical Department, Affiliated Hospital of Hebei University, Baoding, China
- Basic Research Key Laboratory of General Surgery for Digital Medicine, Baoding, China
- Institute of Life Science and Green Development, Hebei University, Baoding, China
- 3D Image and 3D Printing Center, Affiliated Hospital of Hebei University, Baoding, China
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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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Feodorovici P, Arensmeyer J, Schnorr P, Schmidt J. [Extended Reality (XR) - Applications in Thoracic Surgery]. Zentralbl Chir 2023; 148:367-375. [PMID: 37562396 DOI: 10.1055/a-2121-6478] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Extended reality (XR) includes the sub-terms of virtual reality (VR), augmented reality (AR) and mixed reality (MR) and describes interactive and immersive technologies that replace the real world with digital elements or seamlessly extend it with such approaches. XR thus offers a very wide range of possible applications in medicine. In surgery, and thoracic surgery in particular, XR technologies can be harnessed for treatment planning, navigation, training, and patient information. Such applications are increasingly being tested and need to be evaluated. We provide an overview of the status quo of technical development, current surgical applications of XR, and look into the future of the medical XR landscape with integration of artificial intelligence (AI).
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Affiliation(s)
- Philipp Feodorovici
- Sektion Thoraxchirurgie, Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Jan Arensmeyer
- Sektion Thoraxchirurgie, Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Philipp Schnorr
- Klinik für Thoraxchirurgie, Helios Klinikum Bonn/Rhein-Sieg, Bonn, Deutschland
| | - Joachim Schmidt
- Sektion Thoraxchirurgie, Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
- Klinik für Thoraxchirurgie, Helios Klinikum Bonn/Rhein-Sieg, Bonn, Deutschland
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Wang L, Sun D, Gao M, Li C. Computed tomography-guided localization of pulmonary nodules prior to thoracoscopic surgery. Thorac Cancer 2022; 14:119-126. [PMID: 36482812 PMCID: PMC9834693 DOI: 10.1111/1759-7714.14754] [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: 10/16/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
With the increasing awareness of physical examination, the detection rate of pulmonary nodules is gradually increasing. For pulmonary nodules recommended for management by video-assisted thoracic surgery (VATS), preoperative localization of the nodule is required if its location is difficult to determine intraoperatively by palpation. The computed tomography (CT)-guided preoperative localization technique is the most widely used method with low operational difficulty and high efficiency, which can include hook wire, microcoil, medical dye, medical surgical adhesive, combined application, and emerging localization techniques according to the material classification. Each method has its corresponding advantages and disadvantages, but there is still a lack of unified guidelines or standards for the selection of CT-guided preoperative localization methods in clinical practice. This review summarizes the operation precautions, advantages, and shortcomings of the above localization techniques in order to provide references for clinical application.
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Affiliation(s)
- Lixin Wang
- School of Nursing and RehabilitationShandong UniversityJinanChina
| | - Daqian Sun
- Qilu Hospital of Shandong UniversityJinanChina
| | - Min Gao
- School of Nursing and RehabilitationShandong UniversityJinanChina
| | - Chunhai Li
- Qilu Hospital of Shandong UniversityJinanChina
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7
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Advanced Surgical Technologies for Lung Cancer Treatment: Current Status and Perspectives. ENGINEERED REGENERATION 2022. [DOI: 10.1016/j.engreg.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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8
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Chen J, Lin X, Lv Z, Chen M, Huang T. Use of a 3D-printed body surface percutaneous puncture guide plate in vertebroplasty for osteoporotic vertebral compression fractures. PLoS One 2022; 17:e0276930. [PMID: 36441717 PMCID: PMC9704564 DOI: 10.1371/journal.pone.0276930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 10/17/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Percutaneous vertebroplasty (PVP) has been used widely to treat osteoporotic vertebral compression fractures (OVCFs). However, it has many disadvantages, such as excessive radiation exposure, long operation times, and high cement leakage rates. This study was conducted to explore the clinical effects and safety of the use of a three-dimensional (3D)-printed body-surface guide plate to aid PVP for the treatment of OVCFs. METHODS This prospective cohort study was conducted with patients with OVCFs presenting between October 2020 and June 2021. Fifty patients underwent traditional PVP (group T) and 47 patients underwent PVP aided by 3D-printed body-surface guide plates (3D group). The following clinical and adverse events were compared between groups: the puncture positioning, puncture, fluoroscopy exposure and total operation times; changes in vertebral height and the Cobb angle after surgery relative to baseline; preoperative and postoperative visual analog scale and Oswestry disability index scores; and perioperative complications (bone cement leakage, neurological impairment, vertebral infection, and cardiopulmonary complications. RESULTS The puncture, adjustment, fluoroscopy, and total operation times were shorter in the 3D group than in group T. Visual analog scale and Oswestry disability index scores improved significantly after surgery, with significant differences between groups (both p < 0.05). At the last follow-up examination, the vertebral midline height and Cobb angle did not differ between groups. The incidence of complications was significantly lower in the 3D group than in group T (p < 0.05). CONCLUSION The use of 3D-printed body-surface guide plates can simplify and optimize PVP, shortening the operative time, improving the success rate, reducing surgical complications, and overall improving the safety of PVP.
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Affiliation(s)
- Jianquan Chen
- The Second Clinical Medicine College, Guangzhou University of Chinese Medicine, Guangzhou, PR China,Department of Orthopaedics, Guangdong Province Hospital of Traditional Chinese Medicine, Zhuhai Branch, Zhuhai, Guangdong, China
| | - Xinyuan Lin
- The Second Clinical Medicine College, Guangzhou University of Chinese Medicine, Guangzhou, PR China,Department of Orthopaedics, Guangdong Province Hospital of Traditional Chinese Medicine, Zhuhai Branch, Zhuhai, Guangdong, China
| | - Zhouming Lv
- Department of Orthopaedics, Guangdong Province Hospital of Traditional Chinese Medicine, Zhuhai Branch, Zhuhai, Guangdong, China
| | - Maoshui Chen
- Department of Orthopaedics, Guangdong Province Hospital of Traditional Chinese Medicine, Zhuhai Branch, Zhuhai, Guangdong, China
| | - Taosheng Huang
- The Second People’s Hospital of Xiangzhou District of Zhuhai, Guangdong, China,* E-mail:
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9
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Tang H, Yue P, Wei N, Zhang L, Hu W, Sun W, Cao X, Liu L, Lin R, Xu S, Wang C, Ma X, She Y, Ma M, Chen C. Three-dimensional printing template for intraoperative localization of pulmonary nodules in the pleural cavity. JTCVS Tech 2022; 16:139-148. [PMID: 36510546 PMCID: PMC9737054 DOI: 10.1016/j.xjtc.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/16/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives Localization of pulmonary nodules is challenging. However, traditional localization methods have high radiation doses and a high risk of complications. We developed a noninvasive 3-dimensional printing navigational template for intraoperative localization. It can reduce puncture-related complications and simplify the localization process. This study will verify the feasibility of this method. Methods Patients with peripheral pulmonary nodules were included in this study. The computed tomography scan sequences were obtained to design a digital template model, which was then imported into a 3-dimensional printer to produce a physical navigational template. Finally, the navigational template is placed into the patient's pleural cavity for intraoperative localization. The precision of the nodule localization and associated complications were evaluated. Results Twelve patients were finally included in this study. Intraoperative navigational template localization was used in all patients. The success rate of intraoperative nodule localization was 100%, and the median time of localization was 19.5 minutes (range, 16-23.5 minutes). The deviation median of the navigational template was 2.1 mm (range, 1.1-2.7 mm). Among the included patients, no significant complications occurred during intraoperative localization. Conclusions The 3-dimensional printing template for intraoperative localization is feasible, will cause no trauma to the patient, and has acceptable accuracy for application in nodules localization. This navigational template greatly simplifies the localization process and may potentially break the dependence of percutaneous localization on computed tomography scanning.
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Affiliation(s)
- Hai Tang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Peng Yue
- Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China,The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Lanzhou, Gansu Province, China,Medical Quality Control Center in Thoracic Surgery, Lanzhou, Gansu Province, China
| | - Ning Wei
- Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China,The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Lanzhou, Gansu Province, China,Medical Quality Control Center in Thoracic Surgery, Lanzhou, Gansu Province, China
| | - Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Wenteng Hu
- Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China,The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Lanzhou, Gansu Province, China,Medical Quality Control Center in Thoracic Surgery, Lanzhou, Gansu Province, China
| | - Weiyan Sun
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Xiong Cao
- Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China,The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Lanzhou, Gansu Province, China,Medical Quality Control Center in Thoracic Surgery, Lanzhou, Gansu Province, China
| | - Lixin Liu
- Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China,The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Lanzhou, Gansu Province, China,Medical Quality Control Center in Thoracic Surgery, Lanzhou, Gansu Province, China
| | - Ruijiang Lin
- Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China,The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Lanzhou, Gansu Province, China,Medical Quality Control Center in Thoracic Surgery, Lanzhou, Gansu Province, China
| | - Shangqing Xu
- Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China,The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Lanzhou, Gansu Province, China,Medical Quality Control Center in Thoracic Surgery, Lanzhou, Gansu Province, China
| | - Chenhan Wang
- Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China,The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Lanzhou, Gansu Province, China,Medical Quality Control Center in Thoracic Surgery, Lanzhou, Gansu Province, China
| | - Xiang Ma
- Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China,The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Lanzhou, Gansu Province, China,Medical Quality Control Center in Thoracic Surgery, Lanzhou, Gansu Province, China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Minjie Ma
- Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China,The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Lanzhou, Gansu Province, China,Medical Quality Control Center in Thoracic Surgery, Lanzhou, Gansu Province, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China,Address for reprints: Chang Chen, MD, PhD, Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
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10
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Localization Technique Using Mixture of Indigo Carmine and Lipiodol of Pulmonary Nodule via Bronchoscopic Navigation. Medicina (B Aires) 2022; 58:medicina58091235. [PMID: 36143912 PMCID: PMC9505894 DOI: 10.3390/medicina58091235] [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: 07/25/2022] [Revised: 08/31/2022] [Accepted: 09/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: As the number of minimally invasive surgeries, including video-assisted thoracoscopic surgery, increases, small, deeply located lung nodules are difficult to visualize or palpate; therefore, localization is important. We studied the use of a mixture of indigo—carmine and lipiodol, coupled with a transbronchial approach—to achieve accurate localization and minimize patient discomfort and complications. Materials and Methods: A total of 60 patients were enrolled from May 2019 to April 2022, and surgery was performed after the bronchoscopy procedure. Wedge resection or segmentectomy was performed, depending on the location and size of the lesion. Results: In 58/60 (96.7%) patients, the localization of the nodules was successful after localization, and 2/60 required c-arm assistance. None of the patients complained of discomfort during the procedure; in all cases, margins were found to be free from carcinoma, as determined by the final pathology results. Conclusions: We recommend this localization technique using mixture of indigo carmine and lipiodol, in concert with the transbronchial approach, because the procedure time is short, patient’s discomfort is low, and success rate is high.
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Byrd CT, Lui NS, Guo HH. Applications of Three-Dimensional Printing in Surgical Oncology. Surg Oncol Clin N Am 2022; 31:673-684. [DOI: 10.1016/j.soc.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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12
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Assessment of an Artificial Intelligence Mandibular Osteotomy Design System: A Retrospective Study. Aesthetic Plast Surg 2022; 46:1303-1313. [PMID: 35048148 DOI: 10.1007/s00266-021-02698-2] [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: 08/10/2021] [Accepted: 11/15/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND In this study, an AI osteotomy software was developed to design the presurgical plan of mandibular angle osteotomy, which is followed by the comparison between the software-designed presurgical plan and the traditional manual presurgical plan, thus assessing the practicability of applying the AI osteotomy software in clinical practices. METHODS (1) Develop an AI osteotomy software: design an algorithm based on convolutional neural networks capable of learning feature point and processing clustering segmentation; then, select 2296 cases of successful 3D mandibular angle osteotomy presurgical plans, followed by using those 2296 cases to train the deep learning algorithm; (2) compare the osteotomy presurgical plan of AI osteotomy software and that of manual: first step: randomly selecting 80 cases of typical female head 3D CTs, and designing those 80 cases by means of AI osteotomy software designing (group A) and manually designing (group B), respectively; second step: comparing several indexes of group A and those of group B, including the efficiency index (time from input original CT data to osteotomy presurgical plan output), the safety index (the minimum distance from the osteotomy plane to the mandibular canal), the symmetry indexes (bilateral difference of mandibular angle, mandibular ramus height and mandibular valgus angle) and aesthetic indexes (width ratio between middle and lower faces (M/L), mandibular angle and mandibular valgus angle). RESULTS The efficiency index: the design time of group A is 1.768 ± 0.768 min and that of group B is 26.108 ± 1.137 min, with P = 0.000; the safety index: The minimum distances from the osteotomy plane to the mandibular canal are 3.908 ± 0.361mm and 3.651 ± 0.437mm, p = 0.117 in groups A and B, respectively; The symmetry indexes: Bilateral differences of mandibular angle are 1.824 ± 1.834° and 1.567 ± 1.059° in groups A and B, respectively, with P = 0.278; bilateral differences of mandibular ramus height are 2.083 ± 1.263 and 2.965 ± 1.433, respectively, with P = 0.119 in groups A and B; Aesthetic indexes: M/L in groups A and B is 1.364 ± 0.074 and 1.371 ± 0.067, respectively, with P = 0.793; mandibular angles in groups A and B are 127.724 ± 5.800° and 127.242 ± 5.545°, respectively, with P = 0.681; Valgus angles in groups A and B are 11.474 ± 5.380 and 9.743 ± 4.620, respectively, with P = 0.273. CONCLUSIONS With high efficiency, as well as safety, symmetry and aesthetics equivalent to those of a manual design, the AI osteotomy software designing can be used as an alternative method for manual osteotomy designing. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Wang H, Ren T, Chen P, Luo G, Wei N, Tang Y, Wang M. Application of 3-Dimensionally Printed Coplanar Template Improves Diagnostic Yield of CT-Guided Percutaneous Core Needle Biopsy for Pulmonary Nodules. Technol Cancer Res Treat 2022; 21:15330338221089940. [PMID: 35410551 PMCID: PMC9008856 DOI: 10.1177/15330338221089940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and Objective: Computed tomography-guided percutaneous
lung biopsy is a commonly used method for clarifying the nature of nodules,
masses or lung consolidation. However, the diagnostic yield of nodules needs to
be improved when compared with masses during percutaneous lung biopsy. In recent
years, 3D-printed coplanar templates have been gradually utilized in radioactive
seed implantation for lung cancer treatment. However, there is little research
on the application of 3D-printed coplanar templates in pulmonary nodules biopsy.
Therefore, we conducted a single center and retrospective study to explore the
application value of 3D-printed coplanar puncture template-assisted computed
tomography-guided percutaneous core needle biopsy of small pulmonary nodules.
Methods: 210 patients hospitalized in Taihe Hospital with
pulmonary nodules underwent percutaneous core needle biopsy for histopathology
diagnosis and were included in the study. 106 patients underwent conventional
percutaneous lung biopsy (control group) and 104 patients underwent
3D-PCT-assisted percutaneous lung biopsy (3D-PCT group). The diagnostic yield
and incidence of complications were recorded and compared between the two
groups. Results: The overall diagnostic yield significantly
improved in 3D-PCT group (95.2%) compared with Control group (87.7%)
(P < .05); the diagnostic yield for lung nodules smaller
than 2 cm in the 3D-PCT group and the control group was 94.4% and 80.5%,
respectively, (P < .05). Incidence of pneumothorax (17.3% vs
18.9%) and pulmonary hemorrhage (7.7% vs 9.4%) were not significantly difference
between the two groups (P > .05). Conclusions:
Studies indicated that application of 3-Dimensionally printed coplanar template
improves diagnostic yield of CT-guided percutaneous core needle biopsy for
pulmonary nodules, especially for pulmonary nodule smaller than 2 cm.
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Affiliation(s)
- Hansheng Wang
- Department of Pulmonary and Critical Care Medicine, 107632Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Tao Ren
- Department of Pulmonary and Critical Care Medicine, 107632Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Peipei Chen
- Department of Pulmonary and Critical Care Medicine, 107632Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Guoshi Luo
- Department of Pulmonary and Critical Care Medicine, 107632Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Na Wei
- Department of Pulmonary and Critical Care Medicine, 107632Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Yijun Tang
- Department of Pulmonary and Critical Care Medicine, 107632Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Meifang Wang
- Department of Pulmonary and Critical Care Medicine, 107632Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China.,Hubei Key Laboratory of Embryonic Stem Cell Research, 107632Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
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14
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Qing B, Xia Z, Wang W, Gu L, Chen H, Yuan Y. A localization-independent approach for invisible and impalpable ground-glass opacity nodules detection in an in vitro lung specimen: two case reports. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1602. [PMID: 34790808 PMCID: PMC8576721 DOI: 10.21037/atm-21-4966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/14/2021] [Indexed: 11/26/2022]
Abstract
A growing number of ground-glass opacity (GGO) nodules are screened out in lungs. Small GGOs are frequently neither visible nor palpable, thus undetectable during operation. Various nodule localization techniques have been developed to facilitate the intraoperative detection of GGO nodules; however, general localization techniques are infeasible or inappropriate in some cases. The detection of small GGO is a great challenge, even within a surgical specimen in the absence of preoperative localization. A localization-independent approach for GGO detection is urgently needed. Herein, we report two cases with invisible and impalpable small GGO which were not appropriate for preoperative localization. The lesions were anatomically resected under the guidance of three-dimensional (3D) reconstruction and got an adequate margin distance. A vessel (artery, vein, or bronchus) which had advanced into or immediately adjacent to the nodule was assigned as a reference vessel. By dissecting and tracing the reference vessel from proximal to distal, the GGO lesions were successfully detected in the surgical specimens, to the eventual obtainment of an accurate pathological diagnosis. Via the two case reports, we introduced an easily handled approach, namely dissecting and tracing a reference vessel, for GGO detection. The novel approach was first described. Combined with precise anatomical segmentectomy guided by 3D reconstruction, it provides an alternative scheme for GGO resection with no need for preoperative localization.
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Affiliation(s)
- Bei Qing
- Department of Thoracic Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhenkun Xia
- Department of Thoracic Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Wang
- Department of Thoracic Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Linguo Gu
- Department of Thoracic Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Hongzuo Chen
- Department of Thoracic Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Yunchang Yuan
- Department of Thoracic Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
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15
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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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16
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Zhang B, Peng M, Yu F, Mei X, Tang J, Wang X, Liu W, Chen C, Chen X. A novel technique for preoperative localization of pulmonary nodules using a mixture of tissue adhesive and iohexol under computed tomography guidance: A 140 patient single-center study. Thorac Cancer 2021; 12:854-863. [PMID: 33512788 PMCID: PMC7952802 DOI: 10.1111/1759-7714.13826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/01/2020] [Accepted: 12/22/2020] [Indexed: 02/04/2023] Open
Abstract
Background The increase in the incidence of pulmonary nodules has made computed tomography (CT) screening a requirement for diagnosis and treatment. Small pulmonary nodule detection during video‐assisted thoracoscopic surgery (VATS) or thoracotomy is frequently challenging; however, accurate and efficient localization of nodules is critical for precise resection. Herein, we introduce and evaluate the feasibility and safety of a novel technique for preoperative pulmonary nodule localization. Methods From March 2018 to December 2019, 140 patients with 153 pulmonary nodules measuring <2 cm in diameter were enrolled in this study. Preoperative, CT‐guided localization was performed on each nodule with an injected mixture of tissue adhesive and iohexol. Patient and nodule characteristics, localization data, complications, surgical data, and pathological results were analyzed. Results All 153 nodules in 140 patients were successfully marked preoperatively and detected during surgery (n = 153/153). Mean nodule size was 8.7 ± 2.6 mm, and mean distance from nodule to pleura was 7.9 ± 8.2 mm. The mean procedural time was 8.7 ± 1.0 min. Nine patients (6.4%) underwent two simultaneous nodule localizations and two patients (1.4%) underwent three simultaneous nodule localizations. Pneumothorax (17/140, 12.1%), pain (6/140, 4.3%), and pungent odor (5/140, 3.6%) were the major complications. No patient required further treatment, and no allergic reactions or embolisms were observed. Conclusions Preoperative CT‐guided nodule localization using a mixture of tissue adhesive and iohexol is an efficient technique for localizing small and impalpable pulmonary lesions, including multiple pulmonary nodules. Our study demonstrates that this novel method is safe and straightforward to implement.
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Affiliation(s)
- Bingyu Zhang
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China.,Early-Stage Lung Cancer Center, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Muyun Peng
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China.,Early-Stage Lung Cancer Center, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Fenglei Yu
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China.,Early-Stage Lung Cancer Center, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xilong Mei
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jingqun Tang
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China.,Early-Stage Lung Cancer Center, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiang Wang
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China.,Early-Stage Lung Cancer Center, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Wenliang Liu
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China.,Early-Stage Lung Cancer Center, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chen Chen
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.,Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China.,Early-Stage Lung Cancer Center, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaofeng Chen
- Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, The Second Xiangya Hospital of Central South University, Changsha, China.,Early-Stage Lung Cancer Center, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Anesthesia, The Second Xiangya Hospital of Central South University, Changsha, China
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17
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Azari F, Kennedy G, Singhal S. Intraoperative Detection and Assessment of Lung Nodules. Surg Oncol Clin N Am 2020; 29:525-541. [PMID: 32883456 DOI: 10.1016/j.soc.2020.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Lung cancer is the most frequent cause of cancer-related death worldwide. Despite advances in systemic therapy, the 5-year survival remains humbling at 4% to 17%. For those diagnosed early, surgical therapy can yield potentially curative results. Surgical resection remains a cornerstone of medical care. Success hinges on sound oncologic resection principles. Various techniques can be used to identify pulmonary nodules. A challenge is intraoperative assessment of the surgical specimen to confirm disease localization and ensure an R0 resection. The primary tool is frozen section. Understanding the options available enhances the arsenal of thoracic surgeons and leads to better patient care.
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Affiliation(s)
- Feredun Azari
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 White Building, Philadelphia, PA 19104, USA.
| | - Greg Kennedy
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 White Building, Philadelphia, PA 19104, USA
| | - Sunil Singhal
- Department of Surgery, Division of Thoracic Surgery, University of Pennsylvania, Perelman School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 White Building, Philadelphia, PA 19104, USA
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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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Zhang L, Wang L, Kadeer X, Zeyao L, Sun X, Sun W, She Y, Xie D, Li M, Zou L, Rocco G, Yang P, Chen C, Liu CC, Petersen RH, Ng CSH, Parrish S, Zhang YS, Giordano R, di Tommaso L. Accuracy of a 3-Dimensionally Printed Navigational Template for Localizing Small Pulmonary Nodules: A Noninferiority Randomized Clinical Trial. JAMA Surg 2020; 154:295-303. [PMID: 30586136 DOI: 10.1001/jamasurg.2018.4872] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Localization of small lung nodules are challenging because of the difficulty of nodule recognition during video-assisted thoracoscopic surgery. Using 3-dimensional (3-D) printing technology, a navigational template was recently created to assist percutaneous lung nodule localization; however, the efficacy and safety of this template have not yet been evaluated. Objective To assess the noninferiority of the efficacy and safety of a 3-D-printed navigational template guide for localizing small peripheral lung nodules. Design, Setting, and Participants This noninferiority randomized clinical trial conducted between October 2016 and October 2017 at Shanghai Pulmonary Hospital, Shanghai, China, compared the safety and precision of lung nodule localization using a template-guided approach vs the conventional computed tomography (CT)-guided approach. In total, 213 surgical candidates with small peripheral lung nodules (<2 cm) were recruited to undergo either CT- or template-guided lung nodule localization. An intention-to-treat analysis was conducted. Interventions Percutaneous lung nodule localization. Main Outcomes and Measures The primary outcome was the accuracy of lung nodule localization (localizer deviation), and secondary outcomes were procedural duration, radiation dosage, and complication rate. Results Of the 200 patients randomized at a ratio of 1:1 to the template- and CT-guided groups, most were women (147 vs 53), body mass index ranged from 15.4 to 37.3, the mean (SD) nodule size was 9.7 (2.9) mm, and the mean distance between the outer edge of target nodule and the pleura was 7.8 (range, 0.0-43.9) mm. In total, 190 patients underwent either CT- or template-guided lung nodule localization and subsequent surgery. Among these patients, localizer deviation did not significantly differ between the template- and CT-guided groups (mean [SD], 8.7 [6.9] vs 9.6 [5.8] mm; P = .36). The mean (SD) procedural durations were 7.4 (3.2) minutes for the template-guided group and 9.5 (3.6) minutes for the CT-guided group (P < .001). The mean (SD) radiation dose was 229 (65) mGy × cm in the template-guided group and 313 (84) mGy × cm in CT-guided group (P < .001). Conclusions and Relevance The use of the 3-D-printed navigational template for localization of small peripheral lung nodules showed efficacy and safety that were not substantially worse than those for the CT-guided approach while significantly simplifying the localization procedure and decreasing patient radiation exposure. Trial Registration ClinicalTrials.gov identifier: NCT02952261.
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Affiliation(s)
- Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Long Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xiermaimaiti Kadeer
- Department of Thoracic Surgery, The Sixth People's Hospital of Nantong, Jiang Su, People's Republic of China
| | - Li Zeyao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xiwen Sun
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Weiyan Sun
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Mu Li
- Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Liling Zou
- Department of Medical Statistics, Tongji University School of Medicine, Shanghai, People's Republic of China.,Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, New York
| | - Gaetano Rocco
- Department of Thoracic Diseases, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Ping Yang
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Chia-Chuan Liu
- Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - René H Petersen
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Calvin Sze Hang Ng
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Town, Hong Kong
| | | | - Yu Shrike Zhang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raffaele Giordano
- Department of Advanced Biomedical Sciences, Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy
| | - Luigi di Tommaso
- Department of Advanced Biomedical Sciences, Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy
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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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21
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Sun W, Zhang L, Wang L, Ren Y, She Y, Su H, Jiang G, Chen C. Three-Dimensionally Printed Template for Percutaneous Localization of Multiple Lung Nodules. Ann Thorac Surg 2019; 108:883-888. [PMID: 31009631 DOI: 10.1016/j.athoracsur.2019.03.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/21/2019] [Accepted: 03/18/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND When multiple target lung nodules exist, the computed tomography (CT)-guided percutaneous localization procedure becomes complicated. In this study, a three-dimensional (3D)-printed template was designed that could guide hook wire localization of multiple lung nodules. The pilot study aimed for preliminary validation of the feasibility of template-guided localization for multiple lesions. METHODS Patients with multiple lung nodules (<2 cm) and who were scheduled for surgical resection were recruited for participation in this study. After securing their preadmission CT images, the study investigators reconstructed a 3D thorax model from which they designed a digital model as a navigational template. A physical template was then printed for guiding the percutaneous localization of lung nodules. The localization accuracy was evaluated on the basis of the deviation between the localizer and the nodule. RESULTS From April 2018 to November 2018, the study enrolled 16 patients with 34 lung nodules. All nodules were successfully localized under template guidance, with a median procedural time of 10.0minutes (interquartile range [IQR], 8.5-12.6 minutes) and a median radiation exposure of 235 mGy • cm (IQR, 195-254 mGy • cm). The median deviation from the hook wires and nodule centers was 9.0 mm (IQR, 6.2-11.8 mm). Except for 2 cases of pneumothorax without need for further intervention, no complications occurred. CONCLUSIONS Navigational templates built using 3D printing may serve as an effective approach for facilitating localization of multiple lung nodules.
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Affiliation(s)
- Weiyan Sun
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Long Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yijiu Ren
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hang Su
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
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22
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Zhao Z, Jordan S, Tse ZTH. Devices for image-guided lung interventions: State-of-the-art review. Proc Inst Mech Eng H 2019; 233:444-463. [DOI: 10.1177/0954411919832042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lung cancer is the leading cause of cancer-related death. According to the American Cancer Society, there were an estimated 222,500 new cases of lung cancer and 155,870 deaths from lung cancer in the United States in 2017. Accurate localization in lung interventions is one of the keys to reducing the death rate from lung cancer. In this study, a total of 217 publications from 2006 to 2017 about designs of medical devices for localization in lung interventions were screened, shortlisted, and categorized by localization principle and reviewed for functionality. Each study was analyzed for engineering characteristics and clinical significance. Research regarding interventional imaging equipment, navigation systems, and surgical devices was reviewed, and both research prototypes and commercial products were discussed. Finally, the future directions and existing challenges were summarized, including real-time intra-procedure guidance, accuracy of localization, clinical application, clinical adoptability, and clinical regulatory issues.
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Affiliation(s)
- Zhuo Zhao
- School of Electrical and Computer Engineering, College of Engineering, University of Georgia, Athens, GA, USA
| | - Sophie Jordan
- School of Electrical and Computer Engineering, College of Engineering, University of Georgia, Athens, GA, USA
| | - Zion Tsz Ho Tse
- School of Electrical and Computer Engineering, College of Engineering, University of Georgia, Athens, GA, USA
- 3T Technologies LLC, Atlanta, GA, USA
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23
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Zhang C, Lin H, Fu R, Zhang T, Nie Q, Dong S, Yang XN, Wu YL, Zhong WZ. Application of indocyanine green fluorescence for precision sublobar resection. Thorac Cancer 2019; 10:624-630. [PMID: 30734507 PMCID: PMC6449268 DOI: 10.1111/1759-7714.12972] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Increasing identification of small pulmonary nodules promotes sublobar resection, but localization and surgical margins of non-palpable pulmonary nodules through sublobar resection are challenging. Our aim was explicate the feasibility of applying indocyanine green (ICG) fluorescence to localized nodules, and to carry out surgical resection. METHODS A total of 46 patients with subpleural pulmonary nodules <3 cm were enrolled, including 35 for wedge resection and 11 for segmentectomy. For wedge resection, patients underwent computed tomography-guided percutaneous injection of ICG preoperatively. Wedge resection was carried out after confirmation of the fluorescence using fluoroscopy. For segmentectomy, ICG was injected through the peripheral vein during surgery and resection of the segmental plain was carried out. Detailed measurements were taken and information was collected for the whole procedure. RESULTS A total of 33 out of 35 patients underwent successful wedge resection using ICG fluorescence. Segmentectomy was successfully carried out for all 11 patients who underwent the procedure. For two patiens, the nodules failed to be localized with unclear fluorescence, and one patient with an undetected nodule was altered to perform lobectomy. For wedge resection, the mean tumor size and depth from the pleural surface were 7.8 ± 0.5 mm and 10.5 ± 1.6 mm, respectively. The median time taken for preoperative computed tomography-guided percutaneous injection was 28 min (range 18-40 min), and 25 min (range 16-30 min) for wedge resection. For segmentectomy, the ICG fluorescence occurred 14 s after injecting ICG through the peripheral vein, and the median duration was 15 min. All surgical margins were negative based on pathological evaluation. CONCLUSIONS The implementation of ICG fluorescence could provide surgeons carrying out precision sublobar resection with a time-saving surgical technique with less unnecessary intraoperative damage.
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Affiliation(s)
- Chao Zhang
- School of Medicine, South China University of Technology, Guangzhou, China.,Department of Thoracic Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huan Lin
- Department of Breast Cancer, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Rui Fu
- Department of Thoracic Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tao Zhang
- Department of Thoracic Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qiang Nie
- Department of Thoracic Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Song Dong
- Department of Thoracic Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xue-Ning Yang
- Department of Thoracic Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yi-Long Wu
- Department of Thoracic Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wen-Zhao Zhong
- Department of Thoracic Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
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Huang W, Lu J, Chen KM, Wu ZY, Wang QB, Liu JJ, Gong J, Chen ZJ, Ding XY, Wang ZM. Preliminary application of 3D-printed coplanar template for iodine-125 seed implantation therapy in patients with advanced pancreatic cancer. World J Gastroenterol 2018; 24:5280-5287. [PMID: 30581276 PMCID: PMC6295836 DOI: 10.3748/wjg.v24.i46.5280] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate a 3D-printed coplanar template for iodine-125 seed implantation therapy in patients with pancreatic cancer.
METHODS A retrospective analysis of our database was performed, and a total of 25 patients with pancreatic cancer who underwent iodine-125 seed implantation between January 2014 and November 2017 were analyzed. Of these, 12 implantations were assisted by a 3D-printed coplanar template (group A), and 13 implantations performed freehand were selected as a control group (group B). A 3D coplanar template was designed and printed according to a preoperative CT scan and treatment planning system. The iodine-125 seeds were then implanted using the template as a guide. Dosimetric verification was performed after implantation. Pre- and postoperative D90, V100, and V150 were calculated. The success rate of iodine-125 seed implantation, dosimetric parameters, and complications were analyzed and compared between the two groups.
RESULTS Iodine-125 seed implantation was successfully performed in both groups. In group A, the median pre- and postoperative D90 values were 155.32 ± 8.05 Gy and 154.82 ± 16.43 Gy, respectively; the difference between these values was minimal and not statistically significant (P > 0.05). Postoperative V100 and V150 were 91.05% ± 4.06% and 64.54% ± 13.40%, respectively, which met the treatment requirement. A better dosimetric parameter was observed in group A than in group B, and the difference was statistically significant (V100: 91.05% ± 4.06% vs 72.91% ± 13.78%, P < 0.05). No major procedure-related complications were observed in either group. For group A, mild hemorrhage was observed in 1 patient with a peritoneal local hematoma due to mesenteric vein damage from the iodine-125 seed implantation needle. The hematoma resolved spontaneously without treatment. Postoperative blood amylase levels remained within the normal range for all patients.
CONCLUSION A 3D-printed coplanar template appears to be a safe and effective iodine-125 seed implantation guidance tool to improve implantation accuracy and optimize dosimetric distribution.
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Affiliation(s)
- Wei Huang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jian Lu
- Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
| | - Ke-Min Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zhi-Yuan Wu
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Qing-Bin Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jing-Jing Liu
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Ju Gong
- Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
| | - Zhi-Jin Chen
- Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
| | - Xiao-Yi Ding
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zhong-Min Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Kwok JKS, Lau RWH, Zhao ZR, Yu PSY, Ho JYK, Chow SCY, Wan IYP, Ng CSH. Multi-dimensional printing in thoracic surgery: current and future applications. J Thorac Dis 2018; 10:S756-S763. [PMID: 29732197 DOI: 10.21037/jtd.2018.02.91] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Three-dimensional (3D) printing has been gaining much attention in the medical field in recent years. At present, 3D printing most commonly contributes in pre-operative surgical planning of complicated surgery. It is also utilized for producing personalized prosthesis, well demonstrated by the customized rib cage, vertebral body models and customized airway splints. With on-going research and development, it will likely play an increasingly important role across the surgical fields. This article reviews current application of 3D printing in thoracic surgery and also provides a brief overview on the extended and updated use of 3D printing in bioprinting and 4D printing.
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Affiliation(s)
- Jackson K S Kwok
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Rainbow W H Lau
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Ze-Rui Zhao
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Peter S Y Yu
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Jacky Y K Ho
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Simon C Y Chow
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Innes Y P Wan
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Carr SR. Coming soon to an operating theater near you. J Thorac Cardiovasc Surg 2017; 154:2120-2121. [PMID: 29017793 DOI: 10.1016/j.jtcvs.2017.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 09/09/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Shamus R Carr
- Division of Thoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
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