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McCullough MD, Muller M, Egan TM, Buckner GD. Design Optimization and Tradeoff Analysis of an Actuated Continuum Probe for Pulmonary Nodule Localization and Resection. Bioengineering (Basel) 2024; 11:417. [PMID: 38790285 PMCID: PMC11118073 DOI: 10.3390/bioengineering11050417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 05/26/2024] Open
Abstract
Pulmonary nodules are abnormal tissue masses in the lungs, typically less than 3.0 cm in diameter, commonly detected during imaging of the chest and lungs. While most pulmonary nodules are not cancerous, surgical resection may be required if growth is detected between scans. This resection is typically performed without the benefit of intraoperative imaging, making it difficult for surgeons to confidently provide appropriate margins. To enhance the efficacy of wedge resection, researchers have developed a modified ultrasound imaging approach that utilizes both multiple scattering (MS) and single scattering (SS) to enhance the accuracy of margin delineation. Clinical deployment of this novel ultrasound technology requires a highly maneuverable ultrasound probe, ideally one that could be deployed and actuated with minimal invasiveness. This study details the design optimization and tradeoff analysis of an actuated continuum probe for pulmonary nodule localization and resection. This device, deployed through intercostal ports, would enable the intraoperative imaging and precise mapping of nodules for improved margin delineation and patient outcomes. To achieve this objective, multiple objective genetic algorithms (MOGAs) and a design of experiments (DOE) study are used to explore the design space and quantify key dimensional relationships and their effects on probe actuation.
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Affiliation(s)
- Madison D. McCullough
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA; (M.D.M.); (M.M.)
| | - Marie Muller
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA; (M.D.M.); (M.M.)
| | - Thomas M. Egan
- Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA;
| | - Gregory D. Buckner
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA; (M.D.M.); (M.M.)
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Fu L, Wu W, Oblokulov A, Zhu T, Ma Z, Wang H, Wu Y, Li Z, Yu G, Zhang C, Zhang M. Noninvasive 3D-CT simulation versus glue injection to localize small pulmonary nodules prior to anatomical segmentectomy: a randomized controlled trial. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivad156. [PMID: 37725345 PMCID: PMC10764112 DOI: 10.1093/icvts/ivad156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/29/2023] [Accepted: 09/16/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES This study aimed to investigate whether adding glue injection to three-dimensional computed tomography bronchography and angiography (3D-CTBA) has extra benefits to facilitate anatomical segmentectomy for pulmonary nodules. METHODS We conducted a randomized controlled trial. The patients undergoing thoracoscopic segmentectomy assisted with 3D-CTBA simulation were enrolled. Then, they were divided into the 3D-CTBA group and the glue-labelling group who received additional computed tomography-guided percutaneous glue (2-octyl cyanoacrylate) injection to label the nodules. The primary outcome was the resection rate of the nodules, and the secondary measures included the operation time, complications and thorax drainage. RESULTS A total of 173 patients were randomized into the 3D-CTBA group (89 patients) and glue-labelling group (84 patients) between January 2018 and March 2019. Before the segmentectomy, the patients using glue labelling recorded 5 (6.0%) cases of pneumothorax, 2 (2.4%) cases of haemothorax and 1 (1.2%) case of severe chest pain. All the surgical procedure was performed fluently and safely. The resection rate of the nodules was 100% in both groups. Furthermore, these patients demonstrated similar operation time [(141.5 ± 41.9) vs (142.1 ± 38.9) min], estimated blood loss [(111.3 ± 74.0) vs (106.0 ± 63.8) ml], duration of chest tube duration [(5.1 ± 3.0) vs (5.0 ± 3.5) days] and total drainage volume [(872.3 ± 643.1) vs (826.7 ± 806.0) ml], with a P-value of >0.05 respectively. In addition, 6 (7.1%) patients in the glue-labelling group and 6 (6.7%) patients in the 3D-CTBA group reported air leakage (>5 days) and chylothorax. CONCLUSIONS Noninvasive 3D-CTBA alone is probably sufficient to facilitate anatomical segmentectomy. The additional invasive glue labelling could be avoided in selected patients who undergo intentional segmentectomy. CLINICAL TRIAL REGISTRATION The trial was registered under the Chinese Clinical Trial Registry (ChiCTR). Identifier: ChiCTR1800018293, https://www.chictr.org.cn/showproj.html?proj=29345.
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Affiliation(s)
- Linhai Fu
- Department of Thoracic Surgery, Shaoxing People’s Hospital, Shaoxing, China
| | - Wenbin Wu
- Department of Cardiothoracic Surgery, Xuzhou Central Hospital, Xuzhou, China
| | | | - Ting Zhu
- Department of Thoracic Surgery, Shaoxing People’s Hospital, Shaoxing, China
| | - Zhifeng Ma
- Department of Thoracic Surgery, Shaoxing People’s Hospital, Shaoxing, China
| | - Haiyong Wang
- Department of Thoracic Surgery, Shaoxing People’s Hospital, Shaoxing, China
| | - Yuanlin Wu
- Department of Thoracic Surgery, Shaoxing People’s Hospital, Shaoxing, China
| | - Zhupeng Li
- Department of Thoracic Surgery, Shaoxing People’s Hospital, Shaoxing, China
| | - Guangmao Yu
- Department of Thoracic Surgery, Shaoxing People’s Hospital, Shaoxing, China
| | - Chu Zhang
- Department of Thoracic Surgery, Shaoxing People’s Hospital, Shaoxing, China
| | - Miao Zhang
- Department of Cardiothoracic Surgery, Xuzhou Central Hospital, Xuzhou, China
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Lin Z, Yang GM, Ye XB, Liu XB, Chen SS, Zhang YL, Zhuo PQ. Clinical application of two types of Hook-Wire needle localization procedures for pulmonary small nodule biopsy. Technol Health Care 2024; 32:313-320. [PMID: 38669497 PMCID: PMC11191456 DOI: 10.3233/thc-248027] [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] [Indexed: 04/28/2024]
Abstract
BACKGROUND With the widespread use of low-dose spiral computed tomography (LDCT) and increasing awareness of personal health, the detection rate of pulmonary nodules is steadily rising. OBJECTIVE To evaluate the success rate and safety of two different models of Hook-Wire needle localization procedures for pulmonary small nodule biopsy. METHODS Ninety-four cases with a total of 97 pulmonary small nodules undergoing needle localization biopsy were retrospectively analyzed. The cases were divided into two groups: Group A, using breast localization needle steel wire (Bard Healthcare Science Co., Ltd.); Group B, using disposable pulmonary nodule puncture needle (SensCure Biotechnology Co., Ltd.). All patients underwent video-assisted thoracoscopic surgery (VATS) for nodule removal on the same day after localization and biopsy. The puncture localization operation time, success rate, complications such as pulmonary hemorrhage, pneumothorax, hemoptysis, and postoperative comfort were observed and compared. RESULTS In Group A, the average localization operation time for 97 nodules was 15.47 ± 5.31 minutes, with a success rate of 94.34%. The complication rate was 71.69% (12 cases of pneumothorax, 35 cases of pulmonary hemorrhage, 2 cases of hemoptysis), and 40 cases of post-localization discomfort were reported. In Group B, the average localization operation time was 25.32 ± 7.83 minutes, with a 100% success rate. The complication rate was 29.55% (3 cases of pneumothorax, 15 cases of pulmonary hemorrhage, 0 cases of hemoptysis), and 3 cases reported postoperative discomfort. According to the data analysis in this study, Group B had a lower incidence of puncture-related complications than Group A, along with a higher success rate and significantly greater postoperative comfort. CONCLUSIONS The disposable pulmonary nodule puncture needle is safer and more effective in pulmonary small nodule localization biopsy, exhibiting increased comfort compared to the breast localization needle. Additionally, the incidence of complications is significantly lower.
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Affiliation(s)
- Zhong Lin
- Department of Radiology, Xiamen Chang Gung Hospital Hua Qiao University, Fujian, China
| | - Guang-Ming Yang
- Department of Radiology, Xiamen Chang Gung Hospital Hua Qiao University, Fujian, China
| | - Xiu-Bi Ye
- Department of Ultrasound, Xin Yang Street Health Service Center, Xiamen, Fujian, China
| | - Xiang-Bo Liu
- Department of Radiology, Xiamen Chang Gung Hospital Hua Qiao University, Fujian, China
| | - Song-Sen Chen
- Department of Interventional Radiology, the Second Affiliated Hospital of Xiamen Medical College, Fujian, China
| | - Yu-Ling Zhang
- Department of Radiology, Xiamen Chang Gung Hospital Hua Qiao University, Fujian, China
| | - Pi-Qi Zhuo
- Department of Radiology, Xiamen Chang Gung Hospital Hua Qiao University, Fujian, China
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Zuo T, Gao Z, Zhang T, Wen B, Chen B, Jiang P. Preoperative small pulmonary nodule localisation using hookwires or coils: strategy selection in adverse events. J Cardiothorac Surg 2023; 18:237. [PMID: 37488567 PMCID: PMC10367412 DOI: 10.1186/s13019-023-02301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/05/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE This is a retrospective study of adverse events associated with preoperative computed tomography (CT)-guided hookwire or coil localisation. We analysed the experience and process flaws in resecting ground-glass nodules (GGNs) through video-assisted thoracoscopic surgery (VATS) and determined the remedial strategy. METHODS Adverse events were evaluated in 40 patients with 45 GGNs who underwent CT-guided hookwire or coil localisation before VATS. For lesions not successfully marked or detected, palpation, resection of the highly suspected area, segmentectomy or lobectomy was performed. RESULTS Among all adverse events, 15 were dislodgement of the marking materials, 5 were breakaway of the marking materials, 7 were > 2 cm distance between the lesions and the tips, 3 was marking material across the two adjacent lobes, 15 were pneumothorax and 2 were certain parts of marking materials stuck into the chest wall. All GGNs were resected successfully. 20 lesions were detected by palpation. 9 GGNs were discovered after the resection of highly suspected areas. Segmentectomies and lobectomies were performed directly on 7 and 9 GGNs, respectively. CONCLUSIONS When adverse events occur, a second intraoperative localisation, by resecting the highly suspected area either through non-anatomical resection (wedge resection) or anatomical resection (segmentectomy or lobectomy) using the VATS should be considered the alternatives for GGNs localization.
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Affiliation(s)
- Tao Zuo
- Department of Thoracic Surgery, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China
| | - Zhaoming Gao
- Department of Thoracic Surgery, Binzhou People's Hospital, Binzhou, China
| | - Tao Zhang
- Department of Neurosurgery, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China
| | - Bing Wen
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Huanhu West Rd, Tianjin, China
| | - Baojun Chen
- Department of Thoracic Surgery, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China.
| | - Ping Jiang
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, 430071, China.
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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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Yang Q, Han K, Lv S, Li Q, Sun X, Feng X, Kang M. Virtual navigation bronchoscopy-guided intraoperative indocyanine green localization in simultaneous surgery for multiple pulmonary nodules. Thorac Cancer 2022; 13:2879-2889. [PMID: 36058556 PMCID: PMC9575123 DOI: 10.1111/1759-7714.14633] [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: 07/04/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 12/01/2022] Open
Abstract
Background Accurate localization of pulmonary nodules is the main difficulty experienced in wedge resection. Commonly used localization methods have their own advantages and disadvantages. However, clinical work has demonstrated that intraoperative indocyanine green localization under electromagnetic navigation bronchoscopy/virtual navigation bronchoscopy (VNB) is more advantageous than conventional methods for patients with multiple pulmonary nodules undergoing simultaneous surgery, especially for those undergoing bilateral lung surgery. Methods Data of patients undergoing simultaneous surgery for multiple pulmonary nodules with preoperative methylene blue localization by computed tomography (CT)‐guided percutaneous lung puncture (methylene blue group) or intraoperative indocyanine green localization under VNB (virtual navigation group) were retrospectively analyzed. Patient characteristics, pulmonary nodule features, localization time, preoperative location time, location success rate, operation time, complication incidence, visceral pleural staining rate after localization, and pulmonary nodule primary resection success rate were compared between the two groups. Results The methylene blue and virtual navigation groups comprised 39 and 20 patients with 119 and 67 pulmonary nodules resected, respectively. Sex, age, number of pulmonary nodules resected simultaneously, unilateral/bilateral lung surgery, pulmonary nodule size, distance between pulmonary nodules and the visceral pleura, pulmonary nodule consolidation‐to‐tumor ratio, location of pulmonary nodules in the pulmonary lobe, postoperative pathology, visceral pleura staining rate, primary pulmonary nodule resection success rate, and surgical duration did not differ significantly between the groups (p > 0.05). The localization time of the virtual navigation group was significantly shorter than that of the methylene blue group (p < 0.05), regardless of unilateral or bilateral multiple nodules. In the methylene blue group, 25.64% (10/39) of patients presented complications, all of which were pneumothorax, whereas no complications were found in the virtual navigation group. Conclusions For patients with multiple pulmonary nodules undergoing simultaneous surgery, indocyanine green injection under VNB can achieve a similar effect on pulmonary nodule localization as classical methylene blue injection under CT‐guided percutaneous lung puncture, with shorter localization time and fewer complications.
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Affiliation(s)
- Qingjie Yang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, P. R. China.,Department of Thoracic Surgery, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, P. R. China
| | - Kaibao Han
- Department of Thoracic Surgery, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, P. R. China
| | - Shenghua Lv
- Department of Thoracic Surgery, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, P. R. China
| | - Qingtian Li
- Department of Thoracic Surgery, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, P. R. China
| | - Xiaoyan Sun
- Department of Thoracic Surgery, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, P. R. China
| | - Xinhai Feng
- Department of Thoracic Surgery, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, P. R. China
| | - Mingqiang Kang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, P. R. China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
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Tajè R, Gallina FT, Forcella D, Vallati GE, Cappelli F, Pierconti F, Visca P, Melis E, Facciolo F. Fluorescence-guided lung nodule identification during minimally invasive lung resections. Front Surg 2022; 9:943829. [PMID: 35923440 PMCID: PMC9339676 DOI: 10.3389/fsurg.2022.943829] [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: 05/14/2022] [Accepted: 06/24/2022] [Indexed: 11/23/2022] Open
Abstract
In the last few years, minimally invasive surgery has become the standard routine practice to manage lung nodules. Particularly in the case of robotic thoracic surgery, the identification of the lung nodules that do not surface on the visceral pleura could be challenging. Therefore, together with the evolution of surgical instruments to provide the best option in terms of invasiveness, lung nodule localization techniques should be improved to achieve the best outcomes in terms of safety and sensibility. In this review, we aim to overview all principal techniques used to detect the lung nodules that do not present the visceral pleura retraction. We investigate the accuracy of fluorescence guided thoracic surgery in nodule detection and the differences among the most common tracers used.
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Affiliation(s)
- Riccardo Tajè
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Filippo Tommaso Gallina
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Correspondence: Filippo Tommaso Gallina
| | - Daniele Forcella
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Federico Cappelli
- Radiology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federico Pierconti
- Anesthesiology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Visca
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Enrico Melis
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Sekine Y, Koh E, Hoshino H. The efficacy of transbronchial indocyanine green instillation for fluorescent-guided wedge resection. Interact Cardiovasc Thorac Surg 2021; 33:51-59. [PMID: 33729468 DOI: 10.1093/icvts/ivab054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/13/2021] [Accepted: 01/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The purpose of this study was to investigate the feasibility of lung wedge resection by combining 3-dimensional (3D) image analysis with transbronchial indocyanine green (ICG) instillation, in order to delineate the intended area for resection. METHODS From December 2017 to July 2020, 28 patients undergoing wedge resection (17 primary lung cancers, 11 metastatic lung tumours) were enrolled, and fluorescence-guided wedge resection was attempted. Virtual sublobar resections were created preoperatively for each patient using a 3D Image Analyzer. Surgical margins were measured in each sublobar resection simulation in order to select the most optimal surgical resection area. After transbronchial instillation of ICG, near-infrared thoracoscopic visualization allowed matching of the intended area for resection to the virtual sublobar resection area. To investigate the effectiveness of ICG instillation, the clarity of the ICG-florescent border was evaluated, and the distance from the true tumour to the surgical margins was compared to that of simulation. RESULTS Mean tumour diameter was 12.4 ± 4.3 mm. The entire targeted tumour was included in resected specimens of all patients (100% success rate). The shortest distances to the surgical margin via 3D simulation and by actual measurement of the specimen were11.4 ± 5.4 and 12.2 ± 4.1 mm, respectively (P = 0.285) and were well correlated (R2 = 0.437). While all specimens had negative malignant cells at the surgical margins, one loco-regional recurrence was observed secondary to the dissemination of neuroendocrine carcinoma. CONCLUSIONS ICG-guided lung wedge resection after transbronchial ICG instillation and preoperative 3D image analysis allow for adequate negative surgical margins, providing decreased risk of local recurrence.
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Affiliation(s)
- Yasuo Sekine
- Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Eitetsu Koh
- Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Hidehisa Hoshino
- Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
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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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