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Chia AQX, Gogna A, Pena AMT, Sai VVS, Chandramohan S, Chan SJMX, Ong BH. Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series. J Cardiothorac Surg 2024; 19:85. [PMID: 38341594 PMCID: PMC10858515 DOI: 10.1186/s13019-024-02564-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Video-assisted thoracoscopic (VATS) lung resections are increasingly popular and localization techniques are necessary to aid resection. We describe our experience with hybrid operating room (OR) cone-beam computed tomography (CT) assisted pre-operative and intra-operative lesion localization of lung nodules for VATS wedge resections, including our novel workflow using the hybrid OR cone-beam CT to re-evaluate patients who have undergone pre-operative localization for those who are unsuitable for intra-operative localization. METHODS Retrospective analysis of all consecutive patients with small (≤ 20 mm), deep (≥ 10 mm distance from pleura) and/or predominantly ground-glass nodules selected for lesion localization in the Interventional Radiology suite followed by re-evaluation with cone-beam CT in the hybrid OR (pre-operative), or in the hybrid OR alone (intra-operative), prior to intentional VATS wedge performed by a single surgeon at our centre from January 2017 to December 2021. RESULTS 30 patients with 36 nodules underwent localization. All nodules were successfully resected with a VATS wedge resection, although 10% of localizations had hookwire or coil dislodgement. The median effective radiation dose in the pre-operative group was 10.4 mSV including a median additional radiation exposure of 0.9 mSV in the hybrid OR for reconfirmation of hookwire or coil position prior to surgery (p = 0.87). The median effective radiation dose in the intra-operative group was 3.2 mSV with a higher mean rank than the intra-operative group, suggesting a higher radiation dose (p = 0.01). CONCLUSIONS We demonstrate that our multidisciplinary approach utilizing the hybrid OR is safe and effective. Intra-operative localization is associated with lower radiation doses. Routine use of cone-beam CT to confirm the position of the physical marker prior to surgery in the hybrid OR helps mitigate consequences of localization failure with only a modest increase in radiation exposure.
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Affiliation(s)
- Audrey Qi Xin Chia
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
| | - Apoorva Gogna
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
| | | | - Vishnu Vemula Sri Sai
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sivanathan Chandramohan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
| | - Shaun Ju Min Xavier Chan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
| | - Boon-Hean Ong
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
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Yu H, Tian W, Sun Y, Wu Q, Ma C, Jiao P, Huang C, Li D, Tong H. Localization of small peripheral pulmonary nodules for surgical resection: a new intraoperative technique in hybrid operating room. J Cardiothorac Surg 2022; 17:241. [PMID: 36176000 PMCID: PMC9524030 DOI: 10.1186/s13019-022-02012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 09/27/2022] [Indexed: 11/28/2022] Open
Abstract
Objective The purpose of this study was to introduce a new feasible and effective intraoperative localization technique for small peripheral pulmonary nodules in hybrid operating room. Methods Between June 2020 and June 2021, the intraoperative localization was performed in 27 patients for 35 small pulmonary nodules at our institution. The procedure was undergone under thoracoscopic observation. After making the VATS ports, a titanium clip was clipped at the visceral pleura as near the pulmonary nodule as possible to be a marker for the nodule. VATS resection was performed next. Results A total of 27 patients were included in this study, including 6 males and 21 females. The median age was 58 years (range 34–78 years). All surgeries were performed by two-port VATS. A total of 35 pulmonary nodules underwent intraoperative localization. The mean diameter of nodules was 10.6 ± 3.7 mm. The distance of nodules to visceral pleura was 8.3 ± 8.7 mm. The mean localization time was 23.3 ± 3.3 min. The median time of C-arm scanning was 3 (range 2–4) times. The median times for clipping were 2 (range 1–3) times. All the nodules were localized successfully and resected precisely. No VATS were converted to thoracotomy. There were no complications related to localization procedures. Conclusions This new intraoperative localization technique was feasible, safe and effective. And also the intraoperative procedure could avoid extra suffering for patients.
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Affiliation(s)
- Hanbo Yu
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Wenxin Tian
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Yaoguang Sun
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Qingjun Wu
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Chao Ma
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Peng Jiao
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Chuan Huang
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Donghang Li
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Hongfeng Tong
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dong Dan, Beijing, 100730, People's Republic of China.
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Matsuura Y, Nishimura M, Furuichi K, Hirohashi R, Teramukai S, Shimada J, Inoue M. Clinical significance of spread of lipiodol marking for pulmonary nodules and its influence on surgery. Gen Thorac Cardiovasc Surg 2022; 70:1015-1021. [PMID: 35882824 DOI: 10.1007/s11748-022-01842-2] [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: 10/01/2021] [Accepted: 05/25/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Computed tomography (CT)-guided lipiodol marking is one of the targeting methods for resecting small pulmonary nodules or ground-glass nodules in video-assisted thoracic surgery (VATS). However, lipiodol spreading during marking has not been assessed, practically. In this study, we examined the clinical significance and the influence of lipiodol spreading on surgery. METHODS From April 2010 to March 2021, 176 pulmonary nodules in 167 patients were marked with lipiodol under CT guided before VATS. The marking images after lipiodol injection were classified into "Spread" and "non-Spread." Lung resection was sequentially performed on the same day. RESULTS All target nodules were successfully resected in VATS. In the classification of marking images, Spread was 32 (18%), non-Spread was 144 (82%). There was a significant difference in duration of surgery (mean; 138.7 min vs. 118.3 min, p = 0.0496) and amount of bleeding (mean; 32.7 g vs. 11.2 g, p = 0.0173). Provided that limited to the data of wedge resections without intrathoracic pleural adhesion (n = 117), there was no significant difference in duration of surgery (mean; 104.8 min vs. 99.6 min, p = 0.48), amount of bleeding (mean; 4.9 g vs. 5.3 g, p = 0.58). In the multivariate logistic regression analysis, the risk factor of lipiodol spreading was intrathoracic pleural adhesion (odds ratio: 3.16, 95% confidence interval: 1.12-8.97, p = 0.03). There was no relationship between marking image and complication rate. CONCLUSIONS Lipiodol spreading did not directly influence surgery and complication. However, it was a sign of intrathoracic pleural adhesion, which could lead to increased duration of surgery and amount of bleeding.
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Affiliation(s)
- Yoshiaki Matsuura
- Department of Thoracic Surgery, Saiseikai Suita Hospital, 1-2, Kawazonochou, Suita City, Osaka, 564-0013, Japan.,Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Motohiro Nishimura
- Department of Thoracic Surgery, Saiseikai Suita Hospital, 1-2, Kawazonochou, Suita City, Osaka, 564-0013, Japan.
| | - Kinya Furuichi
- Department of Radiology, Saiseikai Suita Hospital, Osaka, 564-0013, Japan
| | - Rina Hirohashi
- Department of Radiology, Saiseikai Suita Hospital, Osaka, 564-0013, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Junichi Shimada
- Graduate School of Nursing for Health Care Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masayoshi Inoue
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
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Fumimoto S, Sato K, Hanaoka N, Katsumata T. Identification of factors affecting the surgical margin in wedge resection using preoperative lipiodol marking. J Thorac Dis 2021; 13:3383-3391. [PMID: 34277034 PMCID: PMC8264669 DOI: 10.21037/jtd-21-211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/09/2021] [Indexed: 12/18/2022]
Abstract
Background The factors affecting the surgical margin distance in resection of small lung lesions after preoperative marking are still unclear. The purpose of this study was to identify these factors in wedge lung resection using a localization technique. Methods The subjects were 45 patients with small pulmonary nodules who underwent preoperative computed tomography-guided lipiodol marking followed by video-assisted thoracoscopic surgery between April 2017 and December 2019. Data were obtained for nodule size, depth from the pleural surface, imaging features, and procedure-related factors that could affect the surgical margin. Subjects were divided into groups with margin distances <10 and ≥10 mm. Logistic regression analysis was used to identify factors associated with the margin distance. Results Preoperative marking was performed using lipiodol prior to resection of 52 nodules (median size, 10.1 mm; range, 6.75-12.3 mm) in 45 patients (23 men, 22 women; median age, 65.4 years). The mean distance from the pleural surface to the pulmonary lesion was 13.8 mm (range, 5.44-22.2 mm). The 3D deviation of the radio-opaque nodule (lipiodol spot) from the lesion was the only significant difference in nodule- and procedure-related factors between the two groups. Multivariate analysis also showed that this 3D deviation was the most significant factor affecting the margin distance (odds ratio, 0.26; 95% CI, 0.08-0.81; P=0.02). Conclusions The findings in this study may help to ensure a sufficient surgical margin after preoperative lipiodol marking, through recognition that the 3D deviation of the radio-opaque nodule from the target lesion has a particularly important influence on the margin distance.
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Affiliation(s)
- Satoshi Fumimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, Japan
| | - Kiyoshi Sato
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, Japan
| | - Nobuharu Hanaoka
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, Japan
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, Japan
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Ito K, Shimada J, Shimomura M, Terauchi K, Nishimura M, Yanada M, Iwasaki Y, Ueshima Y, Kato D, Suzuki H, Inoue M. Safety and reliability of computed tomography-guided lipiodol marking for undetectable pulmonary lesions. Interact Cardiovasc Thorac Surg 2020; 30:546-551. [PMID: 31899511 DOI: 10.1093/icvts/ivz304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/20/2019] [Accepted: 11/24/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the safety and reliability of percutaneous computed tomography (CT)-guided lipiodol marking for undetectable pulmonary lesions before video-assisted thoracic surgery (VATS). METHODS We retrospectively analysed the cases of CT-guided lipiodol marking followed by VATS in 9 institutes from May 2006 to March 2018. Lipiodol (0.2-0.5 ml) was percutaneously injected closely adjacent to undetectable pulmonary lesions with computed-tomography guidance. Lipiodol spots were identified using C-arm-shaped fluoroscopy during VATS. We grasped the lipiodol spots, including the target lesions, with ring-shaped forceps and resected them. RESULTS Of 1182 lesions, 1181 (99.9%) were successfully marked. In 1 case, the injected lipiodol diffused, and no spot was created. Of the 1181 lesions, 1179 (99.8%) were successfully resected with intraoperative fluoroscopy. Two lipiodol spots were not detected because of the lipiodol distribution during the division of pleural adhesions. The mean lesion size was 9.1 mm (range 1-48 mm). The mean distance from the pleural surface was 10.2 mm (range 0-43 mm). Lipiodol marking-induced pneumothorax occurred in 495 (57.1%) of 867 cases. Of these, chest drainage was required in 59 patients (6.8%). The other complications were 19 (2.2%) cases of bloody sputum, 3 (0.35%) cases of intravascular air, 1 (0.12%) case of pneumonia and 1 (0.12%) case of cerebral infarction. There were no lipiodol marking-induced deaths or sequelae. CONCLUSIONS Preoperative CT-guided lipiodol marking followed by VATS resection was shown to be a safe and reliable procedure with a high success rate and acceptably low severe complication rate.
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Affiliation(s)
- Kazuhiro Ito
- Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Thoracic Surgery, Kyoto Yamashiro Medical Center, Kizugawa, Japan
| | - Junichi Shimada
- Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masanori Shimomura
- Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Thoracic Surgery, Ayabe City Hospital, Ayabe, Japan
| | | | | | - Masashi Yanada
- Department of Thoracic Surgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Yasushi Iwasaki
- Department of Thoracic Surgery, Kyoto Chubu Medical Center, Nantan, Japan
| | - Yasuo Ueshima
- Department of Thoracic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Daishiro Kato
- Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hirofumi Suzuki
- Department of Thoracic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Masayoshi Inoue
- Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Lee EM, Lee J, Kim Y, Yi KS, Cho J, Kim J, An JM, Lee D, Kim SJ, An E, Hong YJ, Jo H, Lee SH, Jung Y, Choi CH, Kang JS, Hur J, Kim D. Hybrid Composite of Silver Nanoparticle-Porous Silicon Microparticles as an Image-Guided Localization Agent for Computed Tomography Scan of the Lungs. ACS Biomater Sci Eng 2020; 6:4390-4396. [PMID: 33455188 DOI: 10.1021/acsbiomaterials.0c00611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A hybrid composite of silver nanoparticles (AgNPs) and porous silicon microparticles (pSiMPs) was developed and applied for the computed tomography (CT) scanning of the lungs as an image-guided localization agent. We confirmed the grafting of AgNPs on oxidized pSiMPs template using various analytical equipment, including a scanning electron microscope (SEM), Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD), and energy-dispersive X-ray spectroscopy (EDS). The hybrid composite showed a high CT contrast intensity (>1000 HU) that enabled us to produce and view images of the lungs. In addition, it showed the ability to maintain a strong CT signal at the injected area of the rabbit's lungs, up to an hour, without spreading. The lack of toxicity and immune response indicated that the composite could be fully utilized as a new image-guided localization agent of CT scans for lung cancer surgery.
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Affiliation(s)
| | | | | | - Kyung Sik Yi
- Department of Radiology, Chungbuk National University, Hospital, and Chungbuk National University College of Medicine and Medical Research Institute, Cheongju-si 28644, Republic of Korea
| | - Janggeun Cho
- Department of Radiology, Chungbuk National University, Hospital, and Chungbuk National University College of Medicine and Medical Research Institute, Cheongju-si 28644, Republic of Korea
| | | | | | | | | | | | | | | | | | | | - Chi-Hoon Choi
- Department of Radiology, Chungbuk National University, Hospital, and Chungbuk National University College of Medicine and Medical Research Institute, Cheongju-si 28644, Republic of Korea
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Lee JW, Park CH, Lee SM, Jeong M, Hur J. Planting Seeds into the Lung: Image-Guided Percutaneous Localization to Guide Minimally Invasive Thoracic Surgery. Korean J Radiol 2020; 20:1498-1514. [PMID: 31606955 PMCID: PMC6791818 DOI: 10.3348/kjr.2019.0155] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/18/2019] [Indexed: 12/18/2022] Open
Abstract
Image-guided localization materials are constantly evolving, providing options for the localization of small pulmonary nodules to guide minimally invasive thoracic surgery. Several preoperative methods have been developed to localize small pulmonary lesions prior to video-assisted thoracic surgery. These localization techniques can be categorized into 4 groups according to the materials used: localization with metallic materials (hook-wire, microcoil, or spiral coil), localization with dye (methylene blue or indigo carmine), localization with contrast agents (lipiodol, barium, or iodine contrast agents), and radiotracers (technetium-99m). However, the optimal localization method has not yet been established. In this review article, we discuss the various localization techniques and the advantages and disadvantages of localization techniques as well as the available safety and efficacy data on these techniques.
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Affiliation(s)
- Ji Won Lee
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Min Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Miri Jeong
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Jin Hur
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Imperatori A, Fontana F, Dominioni L, Piacentino F, Macchi E, Castiglioni M, Desio M, Cattoni M, Nardecchia E, Rotolo N. Video-assisted thoracoscopic resection of lung nodules localized with a hydrogel plug. Interact Cardiovasc Thorac Surg 2019; 29:137-143. [PMID: 30793736 DOI: 10.1093/icvts/ivz030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/03/2018] [Accepted: 01/08/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Computed tomography (CT)-guided hydrogel plug deployment was recently proposed for lung nodule preoperative localization and simultaneous prevention of pneumothorax. We analysed our initial experience with CT-guided hydrogel plug localization of lung nodules in patients undergoing video-assisted thoracoscopic (VATS) resection. METHODS We retrospectively evaluated the medical notes from 27 consecutive patients (mean age 68 ± 11 SD years; men 74%) undergoing VATS lung wedge resection for biopsy or definitive treatment of 28 small pulmonary nodules (malignant 82%) at a single institution between October 2017 and July 2018. Difficult intraoperative nodule localization was anticipated with a lesion <10 mm, a depth from pleura:size ratio >1, ground-glass opacity or the judgement of the operating surgeon. All lesions were preoperatively marked by deployment of a CT-guided hydrogel plug. Study end points were frequency of postlocalization pneumothorax; feasibility of delayed surgery; rate of localization of intraoperative nodule and rate of successful VATS resection. RESULTS The mean sizes of the solid nodules (n = 24) and of the ground-glass opacities (n = 4) were, respectively, 10.4 ± 3.4 mm and 16.0 ± 6.2 mm. One (4%) hydrogel plug marking procedure caused a clinically relevant pneumothorax. Nodule resection was scheduled flexibly as required by patient management/operating room scheduling: same day (11 nodules) or delayed [median 6 days (range 1-60 days)]; (17 nodules). All nodules were localized intraoperatively: 25 (89%) by hydrogel plug; 3 (11%) by palpation and pleural puncture hole visible after plug displacement. All nodules were completely excised by VATS, without complications. CONCLUSIONS CT-guided hydrogel plug marking was valuable for VATS localization and resection of challenging lung nodules. The plug minimized clinically relevant pneumothoraxes and allowed flexible surgical schedules.
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Affiliation(s)
- Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Federico Fontana
- Interventional Radiology, Department of Radiology, University of Insubria, Varese, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Filippo Piacentino
- Interventional Radiology, Department of Radiology, University of Insubria, Varese, Italy
| | - Edoardo Macchi
- Interventional Radiology, Department of Radiology, University of Insubria, Varese, Italy
| | - Massimo Castiglioni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Matteo Desio
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Elisa Nardecchia
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Kao MW. Intracorporeal direct measurement for localizing peripheral pulmonary nodules during thoracoscopy. J Thorac Dis 2019; 11:4119-4126. [PMID: 31737294 DOI: 10.21037/jtd.2019.10.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Localizing small lung nodules during thoracoscopy is challenging for thoracic surgeons. In this case series, a novel technique for intraoperative localization that combines preoperative computed tomography (CT) with direct measurement during thoracoscopy is described. Methods A preoperative CT within two months before surgery was mandatory for precise planning of the resection area. During thoracoscopy, intracorporeal direct measurement (ICDM) for intraoperative localization was undergone if the targeted nodule was non-palpable and non-visualized. According to the location of the targeted nodule, longitudinal, and horizontal landmarks were chosen. The distances between the nodule and these landmarks were obtained from both CT images and intraoperative measurements during thoracoscopy. Based on the measurements, the x-axis and y-axis coordinates of the nodule were calculated and marked on the visceral pleura. A thoracoscopic wedge resection with an adequate margin was performed. From July 2014 to December 2018, ICDM was applied in 27 patients with peripheral pulmonary nodules smaller than 2 cm. Their medical records were reviewed retrospectively to evaluate the feasibility and safety of this technique. Results Twenty-six of the twenty-seven nodules were successfully identified (96.3%). The nodules included 13 primary lung cancers, 5 metastases, and 9 benign lesions. The median nodule size was 7 mm (range, 4-17 mm), and the median distance of the nodule from the visceral pleura was 8.1 mm (range, 1.0-31.2 mm). The median localization time was 24 minutes (range, 8-109 mm). Two patients (7.4%) had a prolonged air leak, but there was no procedure-related mortality. Conclusions ICDM is an effective and safe method for localizing peripheral lung nodules during thoracoscopy.
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Affiliation(s)
- Ming-Wei Kao
- Division of Thoracic Surgery, Department of Surgery, E-Da Hospital, Kaohsiung.,School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung
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Park CH, Lee SM, Lee JW, Hwang SH, Kwon W, Han K, Hur J. Hook-wire localization versus lipiodol localization for patients with pulmonary lesions having ground-glass opacity. J Thorac Cardiovasc Surg 2019; 159:1571-1579.e2. [PMID: 31735392 DOI: 10.1016/j.jtcvs.2019.08.100] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/11/2019] [Accepted: 08/20/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Accurate and safe preoperative localization is useful for video-assisted thoracic surgery of small pulmonary lesions with ground-glass opacity (GGO). However, the optimal localization method is unclear. The aim of this study was to compare the usefulness and safety of the lipiodol and hook-wire localization techniques for video-assisted thoracic surgery of GGO lesions. METHODS This prospective, non-randomized comparative study was conducted between April 2014 and December 2016 at 8 qualifying university teaching hospitals. Two-hundred-fifty patients with pulmonary lesions having GGO were included. Patients were assigned in a 1:1 ratio to either the lipiodol (n = 125, 4 hospitals) or hook-wire group (n = 125, 4 hospitals) for preoperative localization procedures. Participants underwent preoperative localization via the lipiodol or hook-wire technique followed by thoracoscopic surgery. The primary endpoint was the procedure success rate. RESULTS The procedure success rates (hook-wire vs lipiodol group) were 94.40% versus 99.16% (P = .08). Localization-related complications occurred in 53.60% versus 48.33% of patients (P = .49). Hemorrhage rates were significantly greater in the hook-wire group than in the lipiodol group (21.6% vs 5.83%, P < .001). The lipiodol procedure time was significantly longer than that of the hook-wire technique (20.69 ± 9.34 vs 17.15 ± 7.91 minutes, P = .001). The initially positive surgical resection margin was significantly greater in the hook-wire group than in the lipiodol group (10.89% vs 2.38%, P = .02). CONCLUSIONS There was no significant difference in success rate between the hook-wire and lipiodol methods. However, the hemorrhage rate was significantly greater in the hook-wire group, whereas the hook-wire group showed greater initially positive surgical resection margins.
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Affiliation(s)
- Chul Hwan Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Min Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Won Lee
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woocheol Kwon
- Department of Radiology, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Hur
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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McDermott S, Fintelmann FJ, Bierhals AJ, Silin DD, Price MC, Ott HC, Shepard JAO, Mayo JR, Sharma A. Image-guided Preoperative Localization of Pulmonary Nodules for Video-assisted and Robotically Assisted Surgery. Radiographics 2019; 39:1264-1279. [PMID: 31419188 DOI: 10.1148/rg.2019180183] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Video-assisted thoracic surgery (VATS) and robotically assisted surgery are used increasingly for minimally invasive diagnostic and therapeutic resection of pulmonary nodules. Unsuccessful localization of small, impalpable, or deep pulmonary nodules can necessitate conversion from VATS to open thoracotomy. Preoperative localization techniques performed by radiologists have improved the success rates of VATS resection for small and subsolid nodules. Any center at which VATS diagnostic resection of indeterminate pulmonary nodules is performed should be supported by radiologists who offer preoperative nodule localization. Many techniques have been described, including image-guided injection of radioisotopes and radiopaque liquids and placement of metallic wires, coils, and fiducial markers. These markers enable the surgeon to visualize the position of an impalpable nodule intraoperatively. This article provides details on how to perform each percutaneous localization technique, and a group of national experts with established nodule localization programs describe their preferred approaches. Special reference is made to equipment required, optimization of marker placement, prevention of technique-specific complications, and postprocedural treatment. This comprehensive unbiased review provides valuable information for those who are considering implementation or optimization of a nodule localization program according to workflow patterns, surgeon preference, and institutional resources in a particular center. ©RSNA, 2019.
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Affiliation(s)
- Shaunagh McDermott
- From the Division of Thoracic Imaging and Intervention (S.M., F.J.F., M.C.P., J.O.S., A.S.) and the Department of Thoracic Surgery (H.C.O.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, St Louis, Mo (A.J.B.); Department of Interventional Radiology, Yale New Haven Hospital, New Haven, Conn (D.D.S.); and Department of Medical Imaging, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.)
| | - Florian J Fintelmann
- From the Division of Thoracic Imaging and Intervention (S.M., F.J.F., M.C.P., J.O.S., A.S.) and the Department of Thoracic Surgery (H.C.O.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, St Louis, Mo (A.J.B.); Department of Interventional Radiology, Yale New Haven Hospital, New Haven, Conn (D.D.S.); and Department of Medical Imaging, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.)
| | - Andrew J Bierhals
- From the Division of Thoracic Imaging and Intervention (S.M., F.J.F., M.C.P., J.O.S., A.S.) and the Department of Thoracic Surgery (H.C.O.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, St Louis, Mo (A.J.B.); Department of Interventional Radiology, Yale New Haven Hospital, New Haven, Conn (D.D.S.); and Department of Medical Imaging, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.)
| | - Douglas D Silin
- From the Division of Thoracic Imaging and Intervention (S.M., F.J.F., M.C.P., J.O.S., A.S.) and the Department of Thoracic Surgery (H.C.O.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, St Louis, Mo (A.J.B.); Department of Interventional Radiology, Yale New Haven Hospital, New Haven, Conn (D.D.S.); and Department of Medical Imaging, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.)
| | - Melissa C Price
- From the Division of Thoracic Imaging and Intervention (S.M., F.J.F., M.C.P., J.O.S., A.S.) and the Department of Thoracic Surgery (H.C.O.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, St Louis, Mo (A.J.B.); Department of Interventional Radiology, Yale New Haven Hospital, New Haven, Conn (D.D.S.); and Department of Medical Imaging, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.)
| | - Harald C Ott
- From the Division of Thoracic Imaging and Intervention (S.M., F.J.F., M.C.P., J.O.S., A.S.) and the Department of Thoracic Surgery (H.C.O.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, St Louis, Mo (A.J.B.); Department of Interventional Radiology, Yale New Haven Hospital, New Haven, Conn (D.D.S.); and Department of Medical Imaging, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.)
| | - Jo-Anne O Shepard
- From the Division of Thoracic Imaging and Intervention (S.M., F.J.F., M.C.P., J.O.S., A.S.) and the Department of Thoracic Surgery (H.C.O.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, St Louis, Mo (A.J.B.); Department of Interventional Radiology, Yale New Haven Hospital, New Haven, Conn (D.D.S.); and Department of Medical Imaging, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.)
| | - John R Mayo
- From the Division of Thoracic Imaging and Intervention (S.M., F.J.F., M.C.P., J.O.S., A.S.) and the Department of Thoracic Surgery (H.C.O.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, St Louis, Mo (A.J.B.); Department of Interventional Radiology, Yale New Haven Hospital, New Haven, Conn (D.D.S.); and Department of Medical Imaging, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.)
| | - Amita Sharma
- From the Division of Thoracic Imaging and Intervention (S.M., F.J.F., M.C.P., J.O.S., A.S.) and the Department of Thoracic Surgery (H.C.O.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, St Louis, Mo (A.J.B.); Department of Interventional Radiology, Yale New Haven Hospital, New Haven, Conn (D.D.S.); and Department of Medical Imaging, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.)
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Hasegawa T, Kuroda H, Sato Y, Matsuo K, Sakata S, Yashiro H, Sakakura N, Mizuno T, Arimura T, Yamaura H, Murata S, Imai Y, Sakao Y, Inaba Y. The Utility of Indigo Carmine and Lipiodol Mixture for Preoperative Pulmonary Nodule Localization before Video-Assisted Thoracic Surgery. J Vasc Interv Radiol 2019; 30:446-452. [DOI: 10.1016/j.jvir.2018.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/17/2022] Open
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Shen C, Li P, Li J, Che G. [Advancement of Common Localization of Solitary Pulmonary Nodules
for Video-assisted Thracoscopic Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:628-634. [PMID: 30172271 PMCID: PMC6105347 DOI: 10.3779/j.issn.1009-3419.2018.08.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
最近,伴随着高分辨多层电子计算机断层扫描(computed tomography, CT)的大量普及,肺小结节的诊断也日益增多,尤其是在伴有肺癌高危因素的患者行CT筛查时尤为明显。电视辅助胸腔镜手术对于肺小结节的诊断和治疗提供了一种全新的微创治疗方式,胸腔镜手术后给患者带来的疼痛感减少、住院时间缩短、手术并发症减少等特点,使其推广更为广泛。如何精准定位及标记病灶,以助电视胸腔镜下切除病灶的方法层出不穷。本文综述近年来胸腔镜下肺小结节定位的各种技术手段,并对各种方法的利弊进行总结及分析。
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Affiliation(s)
- Cheng Shen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Pengfei Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jue Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Fumimoto S, Sato K, Koyama M, Yamamoto K, Narumi Y, Hanaoka N, Katsumata T. Combined lipiodol marking and video-assisted thoracoscopic surgery in a hybrid operating room. J Thorac Dis 2018; 10:2940-2947. [PMID: 29997960 DOI: 10.21037/jtd.2018.05.28] [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: 11/06/2022]
Abstract
Background The development of diagnostic technology has led to detection of an increasing number of small pulmonary nodules (SPNs), which can be difficult to locate intraoperatively. Here, we report our experience performing single-stage lipiodol localization and surgical resection in a hybrid operating room (OR). Methods Between June 2016 and August 2017, 30 patients with 32 SPNs underwent sliding gantry-based multidetector computed tomography (MDCT)-guided lipiodol marking followed by video-assisted thoracoscopic surgery (VATS) in a hybrid OR. After induction of general anesthesia, all nodules were marked with 0.2 mL lipiodol under MDCT fluoroscopic guidance, followed by immediate VATS. Results The mean SPN diameter and distance from the pleural surface were 10.7±4.5 mm (range, 5.0-21.0 mm) and 18.0±9.0 mm (range, 2.8-32.0 mm) respectively. The MDCT-guided localization procedure required 15.8±6.0 min (range, 8.0-32.0 min). All the nodules were marked with lipiodol and detected during fluoroscopy as a clear spot. The median deviation between the radio-opaque nodule and the target nodule was 7.8±3.6 mm (range, 3.0-20.0 mm). In two cases, MDCT scans performed after completion of marking revealed mild pneumothorax, which did not need further intervention. VATS resection was converted to thoracotomy in two patients because of strong pleural adhesions and intraoperative bleeding from the pulmonary vein. No other complications occurred during the combined approach, and there was no intra- or post-operative mortality or morbidity. Conclusions These results suggest that a combined approach using MDCT-guided lipiodol marking followed by VATS is feasible and has acceptable accuracy in resection of SPNs.
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Affiliation(s)
- Satoshi Fumimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Kiyoshi Sato
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Mitsuhiro Koyama
- Department of Radiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Kazuhiro Yamamoto
- Department of Radiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yoshifumi Narumi
- Department of Radiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Nobuharu Hanaoka
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
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Park CH, Im DJ, Lee SM, Lee JW, Hwang SH, Chong S, Cha MJ, Lee KH, Kwon W, Yong HS, Lee JW, Jin GY, Paik SH, Han K, Hur J. LOGIS (LOcalization of Ground-glass-opacity and pulmonary lesions for mInimal Surgery) registry: Design and Rationale. Contemp Clin Trials Commun 2018; 9:60-63. [PMID: 29696225 PMCID: PMC5898551 DOI: 10.1016/j.conctc.2017.12.001] [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: 07/09/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 11/17/2022] Open
Abstract
Background and purpose An optimal pulmonary localization technique for video-assisted thoracic surgery (VATS) of small lung nodules has not yet been established. The LOcalization of Ground-glass-opacity and pulmonary lesions for mInimal Surgery (LOGIS) registry aims to establish a multicenter database and investigate the usefulness and safety of localization techniques for small pulmonary lesions in individuals undergoing VATS. Methods/Design The LOGIS registry is a large-scale, multicenter cohort study, aiming to enroll 825 patients at 10 institutions. Based on the inclusion and exclusion criteria, all study participants with pulmonary lesions indicated for VATS will be screened and enrolled at each site. All study participants will undergo preoperative lesion localization by the hook-wire or lipiodol localization methods according to site-specific methods. Within a few hours of marking, thoracoscopic surgery will be done under general anesthesia by experienced thoracoscopic surgeons. The primary endpoints are the success and complication rates of the two localization techniques. Secondary endpoints include procedure duration, recurrence rate, and all-cause mortality. Study participant enrollment will be completed within 2 years. Procedure success rates and incidence of complications will be analyzed based on computed tomography findings. Procedure duration, recurrence rate, and all-cause mortality will be compared between the two techniques. The study will require 5 years for completion, including 6 months of preparation, 3.5 years for recruitment, and 1 year of follow-up endpoint assessment. Discussion The LOGIS registry, once complete, will provide objective comparative results regarding the usefulness and safety of the lipiodol and hook-wire localization techniques.
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Affiliation(s)
- Chul Hwan Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Jin Im
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Min Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Won Lee
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Semin Chong
- Department of Radiology, Chung-Ang University Medical Center, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Min Jae Cha
- Department of Radiology, Chung-Ang University Medical Center, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Kye Ho Lee
- Department of Radiology, Dankook University Hospital, Cheonan, Chungnam Province, Republic of Korea
| | - Woocheol Kwon
- Department of Radiology, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 80 Guro-dong, Guro-gu, Seoul, 152-703, Republic of Korea
| | - Jae Wook Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 80 Guro-dong, Guro-gu, Seoul, 152-703, Republic of Korea
| | - Gong Yong Jin
- Departments of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
| | - Sang Hyun Paik
- Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Hur
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Moghissi K, Dixon K. Image-guided surgery and therapy for lung cancer: a critical review. Future Oncol 2017; 13:2383-2394. [PMID: 29129114 DOI: 10.2217/fon-2017-0265] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Of the many imaging technologies, some have the potential to be used in image-guided surgery and therapy (IGS/IGT). This review of relevant papers on IGS/IGT for lung cancer indicates effective localization and IGS/IGT in early endobronchial lesions by fluorescence bronchoscopic technique. Visualization of early peripheral (nodular) tumors at operation can be achieved by a variety of imaging methods and devices which allow identification, localization and provision of intraoperative real-time images. Recent developments employing fluorescence contrasts and near infra-red light have shown encouraging feasibility and outcome in providing reliable methods for the IGS of cancer generally and lung cancer more specifically with provision of real time intraoperative imaging. The concept of the hybrid operating theater is touched upon.
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Affiliation(s)
- Keyvan Moghissi
- The Yorkshire Laser Centre, Goole & District Hospital, Woodland Avenue, Goole, East Yorkshire, DN14 6RX, UK
| | - Kate Dixon
- The Yorkshire Laser Centre, Goole & District Hospital, Woodland Avenue, Goole, East Yorkshire, DN14 6RX, UK
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Terra RM, Andrade JR, Mariani AW, Garcia RG, Succi JE, Soares A, Zimmer PM. Applications for a hybrid operating room in thoracic surgery: from multidisciplinary procedures to --image-guided video-assisted thoracoscopic surgery. J Bras Pneumol 2017; 42:387-390. [PMID: 27812640 PMCID: PMC5094877 DOI: 10.1590/s1806-37562015000000177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 05/09/2016] [Indexed: 11/22/2022] Open
Abstract
The concept of a hybrid operating room represents the union of a high-complexity surgical apparatus with state-of-the-art radiological tools (ultrasound, CT, fluoroscopy, or magnetic resonance imaging), in order to perform highly effective, minimally invasive procedures. Although the use of a hybrid operating room is well established in specialties such as neurosurgery and cardiovascular surgery, it has rarely been explored in thoracic surgery. Our objective was to discuss the possible applications of this technology in thoracic surgery, through the reporting of three cases.
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Affiliation(s)
- Ricardo Mingarini Terra
- . Disciplina de Cirurgia Torácica, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Hospital Israelita Albert Einstein, São Paulo (SP) Brasil
| | | | - Alessandro Wasum Mariani
- . Disciplina de Cirurgia Torácica, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Hospital Israelita Albert Einstein, São Paulo (SP) Brasil
| | | | - Jose Ernesto Succi
- . Hospital Israelita Albert Einstein, São Paulo (SP) Brasil.,. Disciplina de Tórax, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo (SP) Brasil
| | - Andrey Soares
- . Hospital Israelita Albert Einstein, São Paulo (SP) Brasil.,. Centro Paulista de Oncologia, São Paulo (SP) Brasil
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Multifunctional nanoparticles as a tissue adhesive and an injectable marker for image-guided procedures. Nat Commun 2017; 8:15807. [PMID: 28722024 PMCID: PMC5524935 DOI: 10.1038/ncomms15807] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 05/02/2017] [Indexed: 12/16/2022] Open
Abstract
Tissue adhesives have emerged as an alternative to sutures and staples for wound closure and reconnection of injured tissues after surgery or trauma. Owing to their convenience and effectiveness, these adhesives have received growing attention particularly in minimally invasive procedures. For safe and accurate applications, tissue adhesives should be detectable via clinical imaging modalities and be highly biocompatible for intracorporeal procedures. However, few adhesives meet all these requirements. Herein, we show that biocompatible tantalum oxide/silica core/shell nanoparticles (TSNs) exhibit not only high contrast effects for real-time imaging but also strong adhesive properties. Furthermore, the biocompatible TSNs cause much less cellular toxicity and less inflammation than a clinically used, imageable tissue adhesive (that is, a mixture of cyanoacrylate and Lipiodol). Because of their multifunctional imaging and adhesive property, the TSNs are successfully applied as a hemostatic adhesive for minimally invasive procedures and as an immobilized marker for image-guided procedures.
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Wang L, Zhang X, Li M, Kadeer X, Dai C, Shi Z, Chen C. Remedial localization after dislodgement of primary mechanical localization in lung surgery. J Thorac Dis 2017; 9:1240-1246. [PMID: 28616274 DOI: 10.21037/jtd.2017.04.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Unhooking or displacement of hookwire or microcoil due to technical failures is rather common. We aim to establish a new technique for remedial localization in the case of displacement or unhooking of primary mechanical localization during lung surgery. METHODS From February 2014 to September 2015, 18 consecutive cases of intraoperative dislodgement during video-assisted thoracoscopic surgery (VATS) were enrolled. Nodule's projection on body surface was located by analyzing computed tomography (CT) images, and a needle was inserted into thoracic cavity through this point. The lung was then inflated, and a small burn was made where the needle tip touched the visceral plural. Wedge resections were subsequently performed for these impalpable small lesions. RESULTS Eighteen solitary pulmonary nodules (SPNs) from 18 patients were scheduled for VATS wedge resections in this series, including 6 (33.3%) hookwire localization and 12 (66.7%) microcoil localization. Fifteen (83.3%) of 18 nodules were pure ground glass opacity (pGGO) and 3 (16.7%) mixed ground glass opacity (mGGO). The mean diameter of SPNs was 7.7±3.6 mm. The mean distance from SPN to pleura was 12.2±10.9 mm. During remedial localization, 17 (94.4%) nodules were removed successfully by wedge resection, and segmentectomy was performed only in one case with failed outcome. Paraffin pathology showed 2 (11.1%) atypical adenomatous hyperplasia (AAH), 11 (61.1%) adenocarcinoma in situ (AIS), 4 (22.2%) minimally invasive adenocarcinoma (MIA), and 1 (5.6%) inflammatory disease. CONCLUSIONS This remedial localization technique is practical and reliable. It is a good backup plan in the case of dislodgement, and it can help prevent extended lung resection.
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Affiliation(s)
- Long Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Xufeng Zhang
- Department of Thoracic Surgery, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
| | - Mu Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Xiermaimaiti Kadeer
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Chenyang Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Zhe Shi
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Kim TH, Park CM, Lee SM, McAdams HP, Kim YT, Goo JM. Percutaneous transthoracic localization of pulmonary nodules under C-arm cone-beam CT virtual navigation guidance. Diagn Interv Radiol 2017; 22:224-30. [PMID: 27015318 DOI: 10.5152/dir.2015.15297] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE We aimed to describe our initial experience with percutaneous transthoracic localization (PTL) of pulmonary nodules using a C-arm cone-beam CT (CBCT) virtual navigation guidance system. METHODS From February 2013 to March 2014, 79 consecutive patients (mean age, 61±10 years) with 81 solid or ground-glass nodules (mean size, 12.36±7.21 mm; range, 4.8-25 mm) underwent PTLs prior to video-assisted thoracoscopic surgery (VATS) excision under CBCT virtual navigation guidance using lipiodol (mean volume, 0.18±0.04 mL). Their procedural details, radiation dose, and complication rates were described. RESULTS All 81 target nodules were successfully localized within 10 mm (mean distance, 2.54±3.24 mm) from the lipiodol markings. Mean number of CT acquisitions was 3.2±0.7, total procedure time was 14.6±5.14 min, and estimated radiation exposure during the localization was 5.21±2.51 mSv. Postprocedural complications occurred in 14 cases (17.3%); complications were minimal pneumothorax (n=10, 12.3%), parenchymal hemorrhage (n=3, 3.7%), and a small amount of hemoptysis (n=1, 1.2%). All target nodules were completely resected; pathologic diagnosis included invasive adenocarcinoma (n=53), adenocarcinoma-in-situ (n=10), atypical adenomatous hyperplasia (n=4), metastasis (n=7), and benign lesions (n=7). CONCLUSION PTL procedures can be performed safely and accurately under the guidance of a CBCT virtual navigation system.
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Affiliation(s)
- Tae Ho Kim
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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Kim KS, Beck KS, Lee KY, Moon SW. CT localization for a patient with a ground-glass opacity pulmonary nodule expecting thoracoscopy: a mixture of lipiodol and India ink. J Thorac Dis 2017; 9:E349-E353. [PMID: 28523176 DOI: 10.21037/jtd.2017.03.58] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Small and deeply seated pure ground-glass opacity (GGO) pulmonary nodules (PNs) are not discernible during video-assisted thoracoscopic surgery (VATS). Moreover, pathologists have difficulty in detecting these nodules due to insufficient localization. We percutaneously injected a mixture of lipiodol and India ink during preoperative CT-guided localization in a 52-year-old female patient presenting with a pure GGO PN. A black-pigmented tattoo lesion was clearly identified, and thoracoscopic wedge resection was performed without difficulty. Pathologic results were also discernible, thus allowing the target lesion to be identified without interruption for microscopic analysis. We introduce a novel method using a mixture of lipiodol and India ink with satisfactory results for preoperative localization of GGO PNs prior to VATS.
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Affiliation(s)
- Kyung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyongmin Sarah Beck
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyo Young Lee
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Park CH, Han K, Hur J, Lee SM, Lee JW, Hwang SH, Seo JS, Lee KH, Kwon W, Kim TH, Choi BW. Comparative Effectiveness and Safety of Preoperative Lung Localization for Pulmonary Nodules. Chest 2017; 151:316-328. [DOI: 10.1016/j.chest.2016.09.017] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/08/2016] [Accepted: 09/09/2016] [Indexed: 11/17/2022] Open
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Donahoe LL, Nguyen ET, Chung TB, Kha LC, Cypel M, Darling GE, de Perrot M, Keshavjee S, Pierre AF, Waddell TK, Yasufuku K. CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature. J Thorac Dis 2016; 8:1986-94. [PMID: 27621851 DOI: 10.21037/jtd.2016.06.74] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) is standard of care for small lung resections at many centres. Computed tomography (CT)-guided insertion of microcoils can aid surgeons in performing VATS resections for non-palpable lung nodules deep to the lung surface. METHODS Retrospective analysis of CT-guided microcoil insertions prior to VATS lung resection at a single institution from October 2008 to January 2014. RESULTS A total of 63 patients were included (37% male, mean age 61.6±11.4 years). Forty-two patients (67%) had a history of smoking, with 10 current smokers. Sixty one (97%) patients underwent wedge resection and 3 (5%) patients had segmentectomy. Three (5%) patients required intra-operative staple line re-resection for positive or close margins. Eleven (17%) patients had a completion lobectomy, 5 of which were during the same anaesthetic. The average time between the CT-guided insertion and start of operation was 136.6±89.0 min, and average operative time was 84.0±53.3 min. The intra-operative complication rate was 5% (n=3), including 1 episode of hemoptysis, and 2 conversions to thoracotomy. The post-operative complication rate was 8% (5 patients), and included 2 air leaks, 1 hemothorax (drop in hemoglobin), 1 post chest tube removal pneumothorax, and one venous infarction of the lingula after lingula-sparing lobectomy requiring completion lobectomy. . Average post-operative length of stay was 2.2 days. A diagnosis was made for all patients. CONCLUSIONS CT-guided microcoil insertion followed by VATS lobectomy is safe, with short operative times, short length of stay and 100% diagnosis of small pulmonary nodules. This technique will become more important in the future with increasing numbers of small nodules detected on CT as part of lung cancer screening programs.
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Affiliation(s)
- Laura L Donahoe
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Elsie T Nguyen
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Tae-Bong Chung
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Lan-Chau Kha
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Marcelo Cypel
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gail E Darling
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Marc de Perrot
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Andrew F Pierre
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Thomas K Waddell
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
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Müller J, Putora PM, Schneider T, Zeisel C, Brutsche M, Baty F, Markus A, Kick J. Handheld single photon emission computed tomography (handheld SPECT) navigated video-assisted thoracoscopic surgery of computer tomography-guided radioactively marked pulmonary lesions. Interact Cardiovasc Thorac Surg 2016; 23:345-50. [PMID: 27207315 DOI: 10.1093/icvts/ivw136] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 04/09/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Radioactive marking can be a valuable extension to minimally invasive surgery. The technique has been clinically applied in procedures involving sentinel lymph nodes, parathyroidectomy as well as interventions in thoracic surgery. Improvements in equipment and techniques allow one to improve the limits. Pulmonary nodules are frequently surgically removed for diagnostic or therapeutic reasons; here video-assisted thoracoscopic surgery (VATS) is the preferred technique. VATS might be impossible with nodules that are small or located deep in the lung. In this study, we examined the clinical application and safety of employing the newly developed handheld single photon emission tomography (handheld SPECT) device in combination with CT-guided radioactive marking of pulmonary nodules. METHODS In this pilot study, 10 subjects requiring surgical resection of a pulmonary nodule were included. The technique involved CT-guided marking of the target nodule with a 20-G needle, with subsequent injection of 25-30 MBq (effective: 7-14 MBq) Tc-99m MAA (Macro Albumin Aggregate). Quality control was made with conventional SPECT-CT to confirm the correct localization and exclude possible complications related to the puncture procedure. VATS was subsequently carried out using the handheld SPECT to localize the radioactivity intraoperatively and therefore the target nodule. A 3D virtual image was superimposed on the intraoperative visual image for surgical guidance. RESULTS In 9 of the 10 subjects, the radioactive application was successfully placed directly in or in the immediate vicinity of the target nodule. The average size of the involved nodules was 9 mm (range 4-15). All successfully marked nodules were subsequently completely excised (R0) using VATS. The procedure was well tolerated. An asymptomatic clinically insignificant pneumothorax occurred in 5 subjects. Two subjects were found to have non-significant discrete haemorrhage in the infiltration canal of the needle. In a single subject, the radioactive marking was unsuccessful because the radioactivity spread into the pleural space. CONCLUSIONS In our series of 10 patients, it was demonstrated that using handheld SPECT in conjunction with VATS to remove radioactively marked pulmonary nodules is feasible. The combination of proven surgical techniques with a novel localization device (handheld SPECT) allowed successful VATS excision of pulmonary nodules which, due to their localization and small size, would typically have required thoracotomy. REGISTRATION ClinicalTrials.gov, NCT02050724, Public 01/29/214, Joachim Müller.
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Affiliation(s)
- Joachim Müller
- Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Tino Schneider
- Department of Pneumology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christoph Zeisel
- Department of Thoracic Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Martin Brutsche
- Department of Pneumology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Florent Baty
- Department of Pneumology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Alexander Markus
- Department of Gynecology and Obstetrics, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jochen Kick
- Department of Thoracic Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Miura H, Yamagami T, Tanaka O, Yoshimatsu R, Ichijo Y, Kato D, Shimada J. CT findings after lipiodol marking performed before video-assisted thoracoscopic surgery for small pulmonary nodules. Acta Radiol 2016; 57:303-10. [PMID: 25795703 DOI: 10.1177/0284185115576047] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 02/08/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND In preoperative lipiodol marking for small pulmonary nodules, lipiodol has a potential risk of distribution in the surrounding lung structure. There are no reports about the detailed accumulation and distribution of lipiodol. PURPOSE To evaluate computed tomography (CT) findings after lipiodol marking before thoracoscopic surgery for pulmonary nodules. MATERIAL AND METHODS Sixty-four consecutive CT-guided lipiodol markings for 103 nodules were performed in 55 patients. Lipiodol (0.2-0.4 mL) was injected using a 21-gauge needle near the nodule. The appearance of lipiodol spots was classified into the following three types on CT: type 1, dense; type 2, punctate; and type 3, unclear. The distribution of lipiodol was also investigated. Statistical analyses were performed on the accumulation and distribution related to nodule factors. Incidences of complications were also investigated. RESULTS A total of 110 markings were performed because of seven additional procedures due to insufficient marking. All nodules were successfully resected on the same day. The appearances of the lipiodol spots were type 1 (82%), type 2 (11%), and type 3 (7.3%). The areas of distribution were lung parenchyma (54%), central bronchus (39%), peripheral bronchovascular bundle (24%), needle tract (20%), pleural space (19%), another segment of ipsilateral lung (5.5%), and contralateral lung (0.9%). Distribution into pleural space and central bronchus was frequently seen in the shallow nodules (P < 0.05). Complications were pneumothorax (61%) and pulmonary hemorrhage (35%). There were no serious symptoms. CONCLUSION The appearance of the lipiodol spot was dense in most cases, despite frequent distribution in the surrounding lung structures without serious complications.
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Affiliation(s)
- Hiroshi Miura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Osamu Tanaka
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Rika Yoshimatsu
- Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yusuke Ichijo
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Daishiro Kato
- Division of Chest Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Junichi Shimada
- Division of Chest Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Sui X, Zhao H, Yang F, Li JL, Wang J. Computed tomography guided microcoil localization for pulmonary small nodules and ground-glass opacity prior to thoracoscopic resection. J Thorac Dis 2015; 7:1580-7. [PMID: 26543605 DOI: 10.3978/j.issn.2072-1439.2015.09.02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND To evaluate the feasibility, safety and efficacy of computed tomography (CT)-guided microcoil localization for small pulmonary lesions prior to thoracoscopic resection. METHODS We retrospectively reviewed the medical data of patients with pulmonary solid nodules and ground-glass opacity (GGO) who underwent CT-guided microcoil localization prior to thoracoscopic surgery. The microcoil was deployed with the proximal end of the microcoil coiling beyond the parietal pleura while the distal part anchoring in the lung parenchyma. After marking with microcoil, the pulmonary lesions were removed by thoracoscopic surgery. RESULTS CT-guided microcoil placements were successful in all 98 lesions, including 14 solid nodules, 11 part-solid GGO, and 73 pure GGO. The mean distance from the lesions to the pleura surface was 11.1±6.6 mm. Eighty-four microcoils (85.7%) were successfully placed with the tails coiled beyond the parietal pleura. Seventeen patients (17.3%) had mild complications after the procedure of localization. Thirteen patients with asymptomatic pneumothorax, only one patient required further thoracentesis, four patients with pulmonary hematoma. Removal of the pulmonary lesions was successful in all patients. Sixty-six lesions (67.3%) were localized through the proximal end of the microcoil beyond the visceral pleura by visual inspection, 29 lesions were localized by palpation of the microcoil or the nodule, and 3 lesions had dislocation of the microcoil, resulting in a success rate of 96.9% for intraoperative localization. CONCLUSIONS CT-guided microcoil localization prior to thoracoscopic resection is a feasible, safe, and effective method for localization of pulmonary small nodules and GGO.
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Affiliation(s)
- Xizhao Sui
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing 100044, China
| | - Hui Zhao
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing 100044, China
| | - Feng Yang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing 100044, China
| | - Ji-Lun Li
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing 100044, China
| | - Jun Wang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing 100044, China
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A Simple and Safe Technique for CT Guided Lung Nodule Marking prior to Video Assisted Thoracoscopic Surgical Resection Revisited. LUNG CANCER INTERNATIONAL 2015; 2015:235720. [PMID: 26579236 PMCID: PMC4633686 DOI: 10.1155/2015/235720] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 10/12/2015] [Indexed: 11/17/2022]
Abstract
Aim. We describe our experience of a simple, safe, and reproducible technique for lung nodule marking prethoracoscopic metastasectomy. Thoracoscopic lung nodule resection reduces patient discomfort, complications, higher level of care, hospital stay, and cost; however, small deeply placed lung nodules are difficult to locate and resect thoracoscopically. Materials and Methods. We describe and review the success of our novel technique, where nodules are identified on a low dose CT and marked with methylene blue using CT fluoroscopy guidance immediately prior to surgery. Results. 30 nodules were marked with a mean size of 8 mm (4-18 mm) located at a mean depth of 17 mm, distributed through both lungs. Dye was detected at the pleural surface in 97% of the patients and at the nodule in 93%. There were no major complications. Thoracoscopic resection was possible in 90%. Conclusion. This is a simple and safe method of lung nodule marking to facilitate thoracoscopic resection in cases where this may not be technically possible due to nodule location.
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Callister MEJ, Baldwin DR, Akram AR, Barnard S, Cane P, Draffan J, Franks K, Gleeson F, Graham R, Malhotra P, Prokop M, Rodger K, Subesinghe M, Waller D, Woolhouse I. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax 2015; 70 Suppl 2:ii1-ii54. [PMID: 26082159 DOI: 10.1136/thoraxjnl-2015-207168] [Citation(s) in RCA: 560] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M E J Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, UK
| | - D R Baldwin
- Nottingham University Hospitals, Nottingham, UK
| | - A R Akram
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | - S Barnard
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle, UK
| | - P Cane
- Department of Histopathology, St Thomas' Hospital, London, UK
| | - J Draffan
- University Hospital of North Tees, Stockton on Tees, UK
| | - K Franks
- Clinical Oncology, St James's Institute of Oncology, Leeds, UK
| | - F Gleeson
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - P Malhotra
- St Helens and Knowsley Teaching Hospitals NHS Trust, UK
| | - M Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - K Rodger
- Respiratory Medicine, St James's University Hospital, Leeds, UK
| | - M Subesinghe
- Department of Radiology, Churchill Hospital, Oxford, UK
| | - D Waller
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - I Woolhouse
- Department of Respiratory Medicine, University Hospitals of Birmingham, Birmingham, UK
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30
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Park CH, Hur J, Lee SM, Lee JW, Hwang SH, Seo JS, Lee KH, Kwon WC, Kim TH, Choi BW. Lipiodol lOcalization for Ground-glass opacity mInimal Surgery: Rationale and design of the LOGIS trial. Contemp Clin Trials 2015; 43:194-9. [DOI: 10.1016/j.cct.2015.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/12/2015] [Accepted: 06/13/2015] [Indexed: 01/15/2023]
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Gill RR, Zheng Y, Barlow JS, Jayender J, Girard EE, Hartigan PM, Chirieac LR, Belle-King CJ, Murray K, Sears C, Wee JO, Jaklitsch MT, Colson YL, Bueno R. Image-guided video assisted thoracoscopic surgery (iVATS) - phase I-II clinical trial. J Surg Oncol 2015; 112:18-25. [PMID: 26031893 PMCID: PMC4539147 DOI: 10.1002/jso.23941] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 05/06/2015] [Indexed: 11/14/2022]
Abstract
Purpose To facilitate localization and resection of small lung nodules, we developed a prospective clinical trial (ClinicalTrials.govnumber NCT01847209) for a novel surgical approach which combines placement of fiducials using intra‐operative C‐arm computed tomography (CT) guidance with standard thoracoscopic resection technique using image‐guided video‐assisted thoracoscopic surgery (iVATS). Methods Pretrial training was performed in a porcine model using C‐arm CT and needle guidance software. Methodology and workflow for iVATS was developed, and a multi‐modality team was trained. A prospective phase I‐II clinical trial was initiated with the goal of recruiting eligible patients with small peripheral pulmonary nodules. Intra‐operative C‐arm CT scan was utilized for guidance of percutaneous marking with two T‐bars (Kimberly‐Clark, Roswell, GA) followed by VATS resection of the tumor. Results Twenty‐five patients were enrolled; 23 underwent iVATS, one withdrew, and one lesion resolved. Size of lesions were: 0.6–1.8 cm, mean = 1.3 ± 0.38 cm.. All 23 patients underwent complete resection of their lesions. CT imaging of the resected specimens confirmed the removal of the T‐bars and the nodule. Average and total procedure radiation dose was in the acceptable low range (median = 1501 μGy*m2, range 665–16,326). There were no deaths, and all patients were discharged from the hospital (median length of stay = 4 days, range 2–12). Three patients had postoperative complications: one prolonged air‐leak, one pneumonia, and one ileus. Conclusions A successful and safe step‐wise process has been established for iVATS, combining intra‐operative C‐arm CT scanning and thoracoscopic surgery in a hybrid operating room. J. Surg. Oncol. 2015 111:18–25. © 2015 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Ritu R Gill
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yifan Zheng
- Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Julianne S Barlow
- Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jagadeesan Jayender
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Erin E Girard
- Siemens Corporation, Corporate Technology, Princeton, New Jersey
| | - Philip M Hartigan
- Department of Anaesthesia, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lucian R Chirieac
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Carol J Belle-King
- Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kristen Murray
- Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Christopher Sears
- Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jon O Wee
- Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael T Jaklitsch
- Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yolonda L Colson
- Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Raphael Bueno
- Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Su TH, Fan YF, Jin L, He W, Hu LB. CT-guided localization of small pulmonary nodules using adjacent microcoil implantation prior to video-assisted thoracoscopic surgical resection. Eur Radiol 2015; 25:2627-33. [PMID: 25773939 DOI: 10.1007/s00330-015-3676-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 02/11/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To describe and assess the localization of small peripheral pulmonary nodules prior to video-assisted thoracoscopic surgical (VATS) resection using the implantation of microcoils. METHODS Ninety-two patients with 101 pulmonary nodules underwent computed tomography (CT)-guided implantation of microcoils proximal to each nodule. Patients were randomly assigned to undergo entire microcoil or leaving-microcoil-end implantations. The complications and efficacy of the two implantation methods were evaluated. VATS resection of lung tissue containing each pulmonary lesion and microcoil were performed in the direction of the microcoil marker. Histopathological analysis was performed for the resected pulmonary lesions. RESULTS CT-guided microcoil implantation was successful in 99/101 cases, and the placement of microcoils within 1 cm of the nodules was not disruptive. There was no difference in the complications and efficacy associated with the entire implantation method (performed for 51/99 nodules) versus the leaving-microcoil-end implantation method (performed for 48/99 nodules). All nodules were successfully removed using VATS resection. Asymptomatic pneumothorax occurred in 16 patients and mild pulmonary haemorrhage occurred in nine patients. However, none of these patients required further surgical treatment. CONCLUSIONS Preoperative localization of small pulmonary nodules using a refined percutaneous microcoil implantation method was found to be safe and useful prior to VATS resection. KEY POINTS • An increasing number of small, indeterminate pulmonary lesions need to be characterized. • Entire microcoil and leaving-microcoil-end implantation methods were described for nodule localization. • Adjacent microcoil localization prior to video-assisted thoracoscopic surgical resection involved minimal intervention. • Preoperative microcoil localization facilitates the definitive resection of small pulmonary nodules.
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Affiliation(s)
- Tian-Hao Su
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 95 YongAn Road, Xicheng District, Beijing, 100050, China
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Bronchoscopic Delivery of Lipiodol as a Fiducial Marker in Lung Tumors Before Radiotherapy. J Thorac Oncol 2014; 9:1579-83. [DOI: 10.1097/jto.0000000000000268] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bolton WD, Howe H, Stephenson JE. The Utility of Electromagnetic Navigational Bronchoscopy as a Localization Tool for Robotic Resection of Small Pulmonary Nodules. Ann Thorac Surg 2014; 98:471-5; discussion 475-6. [PMID: 24968769 DOI: 10.1016/j.athoracsur.2014.04.085] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 04/17/2014] [Accepted: 04/21/2014] [Indexed: 11/26/2022]
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Baumgarten AS, Emtage JB, Wilder RB, Biagioli MC, Gupta S, Spiess PE. Intravesical lipiodol injection technique for image-guided radiation therapy for bladder cancer. Urology 2014; 83:946-50. [PMID: 24397940 DOI: 10.1016/j.urology.2013.09.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/23/2013] [Accepted: 09/13/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION To describe the technique of injecting Lipiodol in the submucosa of the urinary bladder wall as a novel modality to improve localization of muscle-invasive bladder tumors before image-guided radiation therapy. TECHNICAL CONSIDERATIONS Eight patients underwent submucosal Lipiodol injections at transurethral bladder tumor reresection. A rigid cystoscope with a working port was used to inject Lipiodol into bladder submucosa circumferentially around the tumor bed (2-3 mm from margin of resection). Approximately 20-30 injections were used to demarcate the tumor bed for external beam radiation therapy, which was used as part of a bladder-sparing approach. All patients were diagnosed with clinically localized, high-grade, muscle-invasive carcinoma and were deemed nonsurgical candidates or were unwilling to undergo radical cystectomy. Five of the 8 patients received radiation at our institution. Lipiodol injections (95%) were visible on treatment planning computed tomographic scans and kilovoltage portal images throughout the 7-week course of image-guided radiation therapy. In 2 of 5 patients, the tumor bed based on Lipiodol extended outside a planning target volume that would have been treated with radiation therapy based on cystoscopy reports and computed tomographic scans without Lipiodol. There were no adverse events or treatment-related toxicities secondary to Lipiodol injection. CONCLUSION Intravesical Lipiodol injection is an easy-to-perform technique that is safe and effective. Lipiodol serves as a fiducial marker that improves tumor bed localization for radiation therapy, thereby reducing the likelihood of missing the tumor.
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Affiliation(s)
- Adam S Baumgarten
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL
| | - Justin B Emtage
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL
| | - Richard B Wilder
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
| | | | - Shilpa Gupta
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL.
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Jin KN, Lee KW, Kim TJ, Song YS, Kim DI. Computed tomography guided percutaneous injection of a mixture of lipiodol and methylene blue in rabbit lungs: evaluation of localization ability for video-assisted thoracoscopic surgery. J Korean Med Sci 2014; 29:129-36. [PMID: 24431917 PMCID: PMC3890464 DOI: 10.3346/jkms.2014.29.1.129] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 10/22/2013] [Indexed: 11/20/2022] Open
Abstract
Preoperative localization is necessary prior to video assisted thoracoscopic surgery for the detection of small or deeply located lung nodules. We compared the localization ability of a mixture of lipiodol and methylene blue (MLM) (0.6 mL, 1:5) to methylene blue (0.5 mL) in rabbit lungs. CT-guided percutaneous injections were performed in 21 subjects with MLM and methylene blue. We measured the extent of staining on freshly excised lung and evaluated the subjective localization ability with 4 point scales at 6 and 24 hr after injections. For MLM, radio-opacity was evaluated on the fluoroscopy. We considered score 2 (acceptable) or 3 (excellent) as appropriate for localization. The staining extent of MLM was significantly smaller than methylene blue (0.6 vs 1.0 cm, P<0.001). MLM showed superior staining ability over methylene blue (2.8 vs 2.2, P=0.010). Excellent staining was achieved in 17 subjects (81%) with MLM and 8 (38%) with methylene blue (P=0.011). An acceptable or excellent radio-opacity of MLM was found in 13 subjects (62%). An appropriate localization rate of MLM was 100% with the use of the directly visible ability and radio-opacity of MLM. MLM provides a superior pulmonary localization ability over methylene blue.
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Affiliation(s)
- Kwang Nam Jin
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kyung Won Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae Jung Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong Sub Song
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Dong Il Kim
- Department of Pathology, Green Cross Laboratories, Yongin, Korea
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