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Chan PS, Chang LK, Malwade S, Chung WY, Yang SM. Cone Beam CT Derived Laser-Guided Percutaneous Lung Ablation: Minimizing Needle-Related Complications Under General Anesthesia with Lung Separation. Acad Radiol 2024:S1076-6332(24)00284-8. [PMID: 38862349 DOI: 10.1016/j.acra.2024.04.049] [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: 01/23/2024] [Revised: 04/17/2024] [Accepted: 04/29/2024] [Indexed: 06/13/2024]
Abstract
RATIONALE AND OBJECTIVES Percutaneous lung tumor ablations are mostly performed in computed tomography (CT) rooms under local anesthesia with conscious sedation. However, maintaining the breath-hold phase during this can be challenging, affecting image quality and increasing complications. With the advent of hybrid operating rooms (HORs), this procedure can be performed with endotracheal tube (ETGA) intubation under general anesthesia with lung separation, ensuring precise imaging in a single-stage setting. Lung separation provides surgical exposure of one lung while ensuring ample gas exchange with the other. This study evaluated tumor ablations performed in an HOR equipped with cone beam CT and laser guidance. MATERIALS AND METHODS This retrospective study included patients who underwent lung tumor ablation under general anesthesia with an ETGA in an HOR between July 2020 and May 2023. Anesthesia considerations, perioperative management, and postoperative follow-ups were evaluated. RESULTS 65 patients (78 tumors) underwent ablation using two types of lung ventilation methods including a single-lumen tube with a blocker (SLT/BL) (n = 15) and double-lumen tube (DLT) (n = 50). Most patients experienced desaturation during the apnea phase of dynamic CT and needling. The average SpO2 value was significantly lower in the DLT group than in the SLT/BL group during the procedure (81.1% versus 88.7%, P = 0.033). Five, three, and two patients developed pneumothorax, subcutaneous emphysema, and pleural effusion, respectively. CONCLUSION Percutaneous ablation under general anesthesia with endotracheal intubation and lung separation performed in HORs was feasible and safe. The setup minimized complication risks and maintained a balance between patient safety and successful procedures.
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Affiliation(s)
- Pak-Si Chan
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan; Department of Anesthesiology, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Ling-Kai Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | | | - Wen-Yuan Chung
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan; Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Shun-Mao Yang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan; Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan.
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Chang LK, Yang SM, Chung WY, Chen LC, Chang HC, Ho MC, Chang YC, Yu CJ. Cone-beam computed tomography image-guided percutaneous microwave ablation for lung nodules in a hybrid operating room: an initial experience. Eur Radiol 2024; 34:3309-3319. [PMID: 37926741 DOI: 10.1007/s00330-023-10360-5] [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: 01/03/2023] [Revised: 09/09/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES The experience of thermal ablation of lung lesions is limited, especially performing the procedure under localisation by cone-beam CT in the hybrid operation room (HOR). Here, we present the experience of microwave ablation (MWA) of lung nodules in the HOR. METHODS We reviewed patients who underwent image-guide percutaneous MWA for lung nodules in the HOR under general anaesthesia between July 2020 and July 2022. The workflow in the HOR including the pre-procedure preparation, anaesthesia consideration, operation methods, and postoperative care was clearly described. RESULTS Forty lesions in 33 patients who underwent MWA under general anaesthesia (GA) in the HOR were analysed. Twenty-seven patients had a single pulmonary nodule, and the remaining six patients had multiple nodules. The median procedure time was 41.0 min, and the median ablation time per lesion was 6.75 min. The median global operation room time was 115.0 min. The median total dose area product was 14881 μGym2. The median ablation volume was 111.6 cm3. All patients were discharged from the hospital with a median postoperative stay of 1 day. Four patients had pneumothorax, two patients had pleural effusion during the first month of outpatient follow-up, and one patient reported intercostal neuralgia during the 3-month follow-up. CONCLUSIONS Thermal ablation of pulmonary nodules under GA in the HOR can be performed safely and efficiently if we follow the workflow provided. The procedure provides an alternative to managing pulmonary nodules in patients. CLINICAL RELEVANCE STATEMENT Thermal ablation of pulmonary nodules under GA in the HOR can be performed safely and efficiently if the provided workflow is followed. KEY POINTS • We tested the feasibility of microwave ablation of lung lesions performed in a hybrid operating room. • To this end, we provide a description of microwave ablation of the lung under cone-beam CT localisation. • We describe a workflow by which ablation of the pulmonary nodule can be performed safely under general anaesthesia.
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Affiliation(s)
- Ling-Kai Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
| | - Shun-Mao Yang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan.
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan.
| | - Wen-Yuan Chung
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan
| | - Lun-Che Chen
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
| | - Hao-Chun Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Chong-Jen Yu
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
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Purmessur R, Waugh J, Crawford M, Kouritas V. Trans-fissure and trans-lobar coil insertion technique for small lesions positioned inside the fissure. Updates Surg 2023; 75:2377-2381. [PMID: 37495872 DOI: 10.1007/s13304-023-01590-9] [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: 01/28/2023] [Accepted: 07/08/2023] [Indexed: 07/28/2023]
Abstract
The objective of this study is to present a technique of localization of difficult-to-locate lesions inside the fissure by deploying a coil with one of its ends left inside the fissure, and also, to evaluate the safety and the efficiency of this localization technique. Ten (10) patients with lesions in the fissure were identified during discussion at the multidisciplinary team meeting (MDT) and were recruited in the study. Attending surgeons verified that the lesions were unable to be located with minimally invasive approaches. These patients underwent localization of their lesion/s inside the fissure with a coil which was inserted through an adjacent lobe, through the fissure and inside the lesion with the other end protruding inside the fissure. All patients were next subjected to resection of their lesions with minimally invasive approaches. All patients had their lesions resected (with wedge resection or segmentectomies) with adequate margins (R0 resection). No conversion to thoracotomy was necessitated to attempt to palpate the lesion. Small, localized pneumothorax was noted in 7 patients; whereas, all patients had small laceration of their lung parenchyma along the course of the needle without, however, any action needed for these sequalae. The presented technique offers precise localization which leads to successful and safe resection of difficult-to-locate lesions inside the fissure via minimally invasive approaches. The clinical implications of this technique are numerous and its utilization can augment the successful performance of minimally invasive techniques for lesions situated inside the fissure.
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Affiliation(s)
- Rushmi Purmessur
- Department of Thoracic Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - James Waugh
- Department of Interventional Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Michael Crawford
- Department of Interventional Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Vasileios Kouritas
- Department of Thoracic Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK.
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Yu S, Li W, Liu X, Chen X, He X, Duan X, Zhang N, Yan Z, Zhang L. Application value of CT-guided localization using a coil in combination with medical adhesive in sublobar resection. Clin Transl Oncol 2023; 25:2931-2937. [PMID: 37020165 DOI: 10.1007/s12094-023-03156-y] [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: 12/28/2022] [Accepted: 03/14/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE To explore the application value of CT-guided localization using a coil in combination with medical adhesive in sublobar resection. METHODS The clinical data of 90 patients who had small pulmonary nodules and received thoracoscopic sublobar resection during the period from September 2021 to October 2022 in the Department of Thoracic Surgery, Juxian People's Hospital, Shandong Province, were retrospectively analyzed. RESULTS The diameters of 95 pulmonary nodules in the 90 patients in the whole group ranged from 0.40 to 1.24 cm, and their distances from the visceral pleura ranged from 0.51 to 2.15 cm. In these patients, percutaneous lung puncture was successfully performed under local anesthesia, through which coils were implanted in the nodules and medical adhesive was injected around the nodules, with a success rate of localization of 100%. Localization complications included 10 cases of asymptomatic pneumothorax, 9 cases of intrapulmonary hemorrhage, 5 cases of severe pain, and 1 case of pleural reaction, all of which required no special treatment. After preoperative localization, the success rate of resection of pulmonary nodules was 100%, and sufficient surgical margins were obtained. CONCLUSION CT-guided localization using a coil in combination with medical adhesive is a safe, effective, and simple localization method that can meet the requirements of thoracic surgeons for intraoperative localization; for small pulmonary nodules, especially those small-sized and deep-located ground-glass nodules containing few solid mass, this method has important clinical application value, which is a preoperative localization technique worthy of wide application in clinical practice.
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Affiliation(s)
- Shanhai Yu
- Department of Thoracic Surgery, Juxian People's Hospital, Rizhao, 276599, Shandong, China
| | - Wei Li
- Department of Thoracic Surgery, Juxian People's Hospital, Rizhao, 276599, Shandong, China
| | - Xiangding Liu
- Department of Thoracic Surgery, Juxian People's Hospital, Rizhao, 276599, Shandong, China
| | - Xiuguo Chen
- Department of Thoracic Surgery, Juxian People's Hospital, Rizhao, 276599, Shandong, China
| | - Xiaolong He
- Department of Interventional Medicine, Juxian People's Hospital, Rizhao, 276599, Shandong, China
| | - Xianling Duan
- Department of Thoracic Surgery, Juxian People's Hospital, Rizhao, 276599, Shandong, China
| | - Nianxin Zhang
- Department of Thoracic Surgery, Juxian People's Hospital, Rizhao, 276599, Shandong, China
| | - Zhizhong Yan
- Department of Thoracic Surgery, Juxian People's Hospital, Rizhao, 276599, Shandong, China
| | - Liwei Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 South Liyushan Road, Xinshi District, Ürümqi, 830054, Xinjiang Uygur Autonomous Region, China.
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Kadhem SA, Rajendran P. Preoperative CT-Guided Coil Localization of Lung Nodule Resection: A Single-Center Experience. Cureus 2023; 15:e42503. [PMID: 37637515 PMCID: PMC10457019 DOI: 10.7759/cureus.42503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND The increased use of computed tomography (CT) for lung cancer screening has led to an increase in the incidence of lung nodules. However, accurately localizing small or deep-seated nodules remains challenging and often requires image-guided techniques. CT-guided coil localization has emerged as a popular method for precise localization. METHODS A retrospective analysis was conducted on a cohort of patients who underwent CT-guided coil localization followed by surgical resection of lung nodules at the National University Hospital, Singapore, between 2015 and 2021. The study examined the rates of successful localization, procedural complications, and postoperative length of stay. Descriptive statistics were employed for data analysis. RESULTS This retrospective study included 55 patients with pulmonary nodules, of whom 76.4% had a history of previous malignancy. A total of 58 nodules were successfully localized using coil placement and distributed across various lung lobes. The average dimensions of the nodules were 8.4 ± 3.2 mm × 10.1 ± 4.0 mm, with an average distance of 10.9 ± 9.0 mm from the pleura. Surgical resection of the coiled nodules resulted in an average resected volume of 91.1 ± 76.0 cm3 and a resection margin of 9.5 ± 7.3 mm. Failed localization occurred in only 3.6% of cases. Procedural complications were observed in 21.8% of patients, including hemothorax, persistent air leaks, pneumothoraces, pleural effusion, pneumonia, and atelectasis, all of which were appropriately managed. The average length of postoperative hospital stay was 6.7 ± 15.9 days. CONCLUSION Preoperative CT-guided coil localization is a reliable and safe technique for accurately localizing lung nodules before surgical resection. The high success rate of this approach enables precise intraoperative planning. Despite procedural complications, their manageable nature and the absence of major adverse events highlight the safety of this technique. Incorporating CT-guided coil localization into routine clinical practice can significantly enhance surgical planning, improve patient outcomes, and optimize resource utilization.
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Nguyen ET, Bayanati H, Hurrell C, Aitken M, Cheung EM, Gupta A, Harris S, Sedlic T, Taylor JL, Gahide G, Dennie C. Canadian Association of Radiologists/Canadian Association of Interventional Radiologists/Canadian Society of Thoracic Radiology Guidelines on Thoracic Interventions. Can Assoc Radiol J 2022; 74:272-287. [PMID: 36154303 DOI: 10.1177/08465371221122807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Thoracic interventions are frequently performed by radiologists, but guidelines on appropriateness criteria and technical considerations to ensure patient safety regarding such interventions is lacking. These guidelines, developed by the Canadian Association of Radiologists, Canadian Association of Interventional Radiologists and Canadian Society of Thoracic Radiology focus on the interventions commonly performed by thoracic radiologists. They provide evidence-based recommendations and expert consensus informed best practices for patient preparation; biopsies of the lung, mediastinum, pleura and chest wall; thoracentesis; pre-operative lung nodule localization; and potential complications and their management.
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Affiliation(s)
- Elsie T Nguyen
- Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Hamid Bayanati
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Matthew Aitken
- Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada,St. Michael's Hospital, University of Toronto, ON, Canada
| | - Edward M Cheung
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Ashish Gupta
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Scott Harris
- Health Sciences Centre, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Tony Sedlic
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jana Lyn Taylor
- Department of Diagnostic Radiology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Gerald Gahide
- Service de radiologie interventionelle, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Carole Dennie
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada,Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Yang F, Min J. Hemorrhagic shock caused by preoperative computed tomography-guided microcoil localization of lung nodules: a case report. BMC Surg 2022; 22:247. [PMID: 35761236 PMCID: PMC9238084 DOI: 10.1186/s12893-022-01696-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/21/2022] [Indexed: 11/21/2022] Open
Abstract
Background Video-assisted thoracoscopic surgery (VATS) is an emerging technology in minimally invasive surgery, which has become recognized as standard treatments for early-stage lung cancer. Microcoil localization is considered to be a safe and effective way of preoperative localization, and is essential to facilitate VATS wedge-resection for lung nodules. Case presentation Here we report a rare case of a 28-year-old female who developed hemorrhagic shock caused by delayed pneumothorax after preoperative computed tomography (CT)-guided microcoil localization. The thoracic CT revealed hydropneumothorax in the right thoracic cavity at 10 h after microcoil localization, and the patient later had significant decreased hemoglobin level (87 g/L). Emergency thoracoscopic exploration demonstrated that the hemorrhagic shock was induced by delayed pneumothorax, which led to the fracture of an adhesive pleura cord and an aberrant vessel. Electrocoagulation hemostasis was then performed for the fractured vessel and the patient gradually recovered from the hypovolemic shock. Conclusions Microcoil localization is a relatively safe and effective way of preoperative localization of lung nodules, however, hemorrhagic shock could be induced by rupture of pleural aberrant vessels subsequent to puncture related pneumothorax. Shorten the time interval between localization and thoracoscopic surgery, extend the monitoring time after localization might help to reduce the risk of these complications.
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Ala M, Liu J, Kou J, Wang X, Sun M, Hao C, Wu J. The risk factors for the failure of hook wire localization of ground glass nodules prior to thoracoscopic surgery. J Cardiothorac Surg 2022; 17:114. [PMID: 35546677 PMCID: PMC9092699 DOI: 10.1186/s13019-022-01866-y] [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: 08/26/2021] [Accepted: 03/20/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To retrospectively analyse the potential influencing factors of CT-guided hook wire localization failure prior to thoracoscopic resection surgery of ground glass nodules (GGNs), and determine the main risk elements for localization failure. Methods In all, 372 patients were included in this study, with 21 patients showing localization failure. The related parameters of patients, GGNs, and localization were analysed through univariate and multiple logistic regression analysis to determine the risk factors of localization failure. Results Univariate logistic regression analysis indicated that trans-fissure (odds ratio [OR] 4.896, 95% confidence interval [CI] 1.489–13.939); trans-emphysema (OR 3.538, 95% CI 1.343–8.827); localization time (OR 0.956, 95% CI 0.898–1.019); multi-nodule localization (OR 2.597, 95% CI 1.050–6.361); and pneumothorax (OR 10.326, 95% CI 3.414–44.684) were risk factors for localization failure, and the p-values of these factors were < 0.05. However, according to the results of multivariate analysis, pneumothorax (OR 5.998, 95% CI 1.680–28.342) was an exclusive risk factor for the failure of preoperative localization of GGNs. Conclusion CT-guided hook wire localization of GGNs prior to thoracoscopic surgery is often known to fail; however, the incidence is low. Pneumothorax is an independent risk factor for failure in the localization process.
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Affiliation(s)
- Musu Ala
- Graduate School, Tianjin Medical University, Tianjin, 300070, People's Republic of China.,Department of Ultrasound, The Affiliated Hospital of Inner Mongolia Medial University, Hohhot, Inner Mongolia, 010050, People's Republic of China
| | - Junzhong Liu
- Department of Radiology, Weifang People's Hospital, The First Affiliated Hospital of Weifang Medical University, Weifang, 261041, Shandong, People's Republic of China
| | - Jieli Kou
- Department of Medical Imaging, Cangzhou People's Hospital, Cangzhou, 061001, Hebei, People's Republic of China
| | - Xinhua Wang
- Department of Radiology, Weifang No. 2 People's Hospital, The Second Affiliated Hospital of Weifang Medical University, Weifang, 261041, Shandong, People's Republic of China
| | - Minfeng Sun
- Department of Radiology, Weifang No. 2 People's Hospital, The Second Affiliated Hospital of Weifang Medical University, Weifang, 261041, Shandong, People's Republic of China
| | - Changcheng Hao
- Thoracic Surgery Department, Weifang No. 2 People's Hospital, The Second Affiliated Hospital of Weifang Medical University, Weifang, 261041, Shandong, People's Republic of China
| | - Jianlin Wu
- Graduate School, Tianjin Medical University, Tianjin, 300070, People's Republic of China. .,Department of Medical Imaging, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Street, Dalian, 116001, Liaoning, People's Republic of China.
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Chang CJ, Lu CH, Gao X, Fang HY, Chao YK. Safety and Efficacy of Cone-Beam Computed Tomography-Guided Lung Tumor Localization with a Near-Infrared Marker: A Retrospective Study of 175 Patients. Life (Basel) 2022; 12:life12040494. [PMID: 35454984 PMCID: PMC9033024 DOI: 10.3390/life12040494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/17/2022] [Accepted: 03/27/2022] [Indexed: 12/19/2022] Open
Abstract
Preoperative localization holds promise for overcoming the limitations of video-assisted thoracoscopic surgery (VATS) in the treatment of impalpable lung nodules. The purpose of this study was to assess the safety and efficacy of cone-beam computed tomography (CBCT)-guided localization using near-infrared (NIR) marking. Between 2017 and 2021, patients presenting with a solitary pulmonary nodule (SPN) who had undergone CBCT-guided lesion localization with indocyanine green (ICG) in a hybrid operating room were included. The primary outcomes were the efficacy of localization and the occurrence of complications. The study cohort consisted of 175 patients with the mean age of 58.76 years. The mean size and depth of the 175 SPNs were 8.34 mm and 5.3 mm, respectively. The mean time required for lesion marking was 14.71 min. Upon thoracoscopic inspection, the NIR tattoo was detected in the vast majority of the study participants (98.3%). An utility thoracotomy to allow digital palpation was required in two of the three patients in whom the tattoo was not identifiable. The perioperative survival rate was 100%, and the mean length of hospital stay was 3.09 days. We conclude that needle localization with ICG injection is a safe and feasible technique to localize SPNs prior to resection.
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Affiliation(s)
| | | | | | | | - Yin-Kai Chao
- Correspondence: ; Tel.: +886-3-328-1200 (ext. 2118); Fax: +886-3-328-5818
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Huang ZG, Wang CL, Sun HL, Qin SZ, Li CD, Gao BX. CT-guided microcoil localization of pulmonary nodules: the effect of the position of microcoil proximal end on the incidence of microcoil dislocation. Br J Radiol 2022; 95:20200381. [PMID: 34672681 PMCID: PMC8722258 DOI: 10.1259/bjr.20200381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To evaluate the effect of the position of microcoil proximal end on the incidence of microcoil dislocation during CT-guided microcoil localization of pulmonary nodules (PNs). METHODS This retrospective study included all patients with PNs who received CT-guided microcoil localization before video-assisted thoracoscopic urgery (VATS) resection from June 2016 to December 2019 in our institution. The microcoil distal end was less than 1 cm away from the nodule, and the microcoil proximal end was in the pleural cavity (the pleural cavity group) or chest wall (the chest wall group). The length of microcoil outside the pleura was measured and divided into less than 0.5 cm (group A), 0.5 to 2 cm (group B) and more than 2 cm (group C). Microcoil dislocation was defined as complete retraction into the lung (type I) or complete withdrawal from the lung (type II). The rate of microcoil dislocation between different groups was compared. RESULTS A total of 519 consecutive patients with 571 PNs were included in this study. According to the position of microcoils proximal end on post-marking CT, there were 95 microcoils in the pleural cavity group and 476 in the chest wall group. The number of microcoils in group A, B, and C were 67, 448 and 56, respectively. VATS showed dislocation of 42 microcoils, of which 30 were type II and 12 were type I. There was no statistical difference in the rate of microcoil dislocation between the pleural cavity group and the chest wall group (6.3% vs 7.6%, x2 = 0.18, p = 0.433). The difference in the rate of microcoil dislocation among group A, B, and C was statistically significant (11.9%, 5.8%, and 14.3% for group A, B, and C, respectively, x2 = 7.60, p = 0.008). In group A, 75% (6/8) of dislocations were type I, while all eight dislocations were type II in group C. CONCLUSIONS During CT-guided microcoil localization of PNs, placing the microcoil proximal end in the pleura cavity or chest wall had no significant effect on the incidence of microcoil dislocation. The length of microcoil outside the pleura should be 0.5 to 2 cm to reduce the rate of microcoil dislocation. ADVANCES IN KNOWLEDGE: CT-guided microcoil localization can effectively guide VATS to resect invisible and impalpable PNs. Microcoil dislocation is the main cause of localization failure. The length of microcoil outside the pleura is significantly correlated with the rate and type of microcoil dislocation. Placing the microcoil proximal end in the pleura cavity or chest wall has no significant effect on the rate of microcoil dislocation.
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Affiliation(s)
- Zhen-Guo Huang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Cun-li Wang
- Department of Radiology, Baotou Third Hospital, Baotou, China
| | - Hong-liang Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Shu-Zhu Qin
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Chuan-Dong Li
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Bao-Xiang Gao
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
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Su KW, Singhal S, Sarkaria IS. Intraoperative imaging and localization techniques for part-solid nodules. JTCVS Tech 2021; 10:468-472. [PMID: 34984397 PMCID: PMC8691937 DOI: 10.1016/j.xjtc.2021.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Katherine W. Su
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Sunil Singhal
- Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Inderpal S. Sarkaria
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center, Pittsburgh, Pa
- Address for reprints: Inderpal S. Sarkaria, MD, UPMC Shadyside Medical Building, 5200 Centre Ave, Suite 715, Pittsburgh, PA 15232.
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Zhang G, Xu D, Yu Z, Wang L, Gu H, Chai Y, Shen G. Preoperative non-invasive visual localization of synchronous multiple lung cancers using three-dimensional computed tomography lung reconstruction. J Cardiothorac Surg 2021; 16:273. [PMID: 34565436 PMCID: PMC8474893 DOI: 10.1186/s13019-021-01666-w] [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: 01/06/2021] [Accepted: 09/21/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Synchronous multiple primary lung cancers are becoming more common with increasing use of computed tomography for screening. Intraoperative localization and resection of ill-defined pulmonary ground-glass opacities during thoracoscopic resection is challenging. This study aimed to determine the clinical feasibility of non-invasive visual localization of these nodules by three-dimensional computed tomography lung reconstruction before sublobar resection. METHODS Forty-four patients with synchronous multiple primary lung cancers underwent thoracoscopic pulmonary resection at our institution between June 2017 and August 2019. Preadmission computed tomography images were downloaded and reconstructed into a three-dimensional model. Small nodules (< 15 mm) were localized non-invasively by three-dimensional computed tomography lung reconstruction before surgery. Patient demographics, nodule characteristics, procedural details, pathological data, and outcomes were obtained from the medical records. RESULTS One hundred and twenty-one pulmonary nodules from the 44 patients were scheduled for video-assisted thoracic surgery; 54 (44.6%) were pure ground-glass opacities and 57 (47.1%) were mixed ground-glass opacities. One hundred and seventeen nodules were localized preoperatively. The mean nodule diameter was 7.67 ± 3.87 mm. The mean distance from the nodule to the pleura was 14.84 ± 14.43 mm. All nodules were removed successfully by wedge resection (27 patients), lobectomy (26 patients), or segmentectomy (25 patients). Most lesions (85.1%) were malignant. Paraffin pathology revealed 12 cases of atypical adenomatous hyperplasia (9.92%), 13 of adenocarcinoma in situ (10.74%), 16 of minimally invasive adenocarcinoma (13.22%), and 73 of invasive adenocarcinoma (60.33%). CONCLUSIONS Three-dimensional computed tomography lung reconstruction is a feasible and alternative method of visual localization for small lung nodules before sublobar resection in some suitable patients.
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Affiliation(s)
- Guofei Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Duo Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Zipu Yu
- Department of Thoracic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Lian Wang
- Department of Thoracic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Haihua Gu
- Department of Thoracic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Ying Chai
- Department of Thoracic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Gang Shen
- Department of Thoracic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China.
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Sato M, Kobayashi M, Sakamoto J, Fukai R, Takizawa H, Shinohara S, Kojima F, Sakurada A, Nakajima J. The role of virtual-assisted lung mapping 2.0 combining microcoils and dye marks in deep lung resection. J Thorac Cardiovasc Surg 2021; 164:243-251.e5. [PMID: 34654560 DOI: 10.1016/j.jtcvs.2021.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/04/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Virtual-assisted lung mapping 2.0 is a novel preoperative bronchoscopic lung mapping technique combining the multiple dye marks of conventional virtual-assisted lung mapping with intrabronchial microcoils to navigate thoracoscopic deep lung resection. This study's purpose was to evaluate the feasibility of virtual-assisted lung mapping 2.0 in resecting deeply located pulmonary nodules with adequate margins. METHODS A multicenter, prospective single-arm study was performed from 2019 to 2020 in 8 institutions. The selection criteria were barely identifiable nodules requiring sublobar lung resections, nodules requiring resection lines reaching the inner 2/3 of the pulmonary lobe on computed tomography images in wedge resection, or the nodule center located in the inner 2/3 of the pulmonary lobe in wedge resection or segmentectomy. Resection margins larger than 2 cm or the nodule diameter were considered successful resection. Bronchoscopic placement of multiple dye marks and microcoil(s) was conducted 0 to 2 days before surgery. RESULTS We analyzed 65 lesions in 64 patients. The diameter and depth of the targeted nodules and the minimum required resection depth reported as median (interquartile range) were 9 (7-13) mm, 11 (5-15) mm, and 30 (25-35) mm, respectively. Among 60 wedge resections and 5 segmentectomies, successful resection was achieved in 64 of 65 resections (98.5%; 95% confidence interval, 91.7-100). Among 75 microcoils placed, 3 showed major displacement after bronchoscopic placement. There were no severe adverse events associated with the virtual-assisted lung mapping procedure. CONCLUSIONS This study demonstrated that virtual-assisted lung mapping 2.0 can facilitate successful resections for deep pulmonary nodules, overcoming the limitations of conventional virtual-assisted lung mapping.
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Affiliation(s)
- Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan.
| | - Masashi Kobayashi
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jin Sakamoto
- Department of Thoracic Surgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Ryuta Fukai
- Department of Thoracic Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hiromitsu Takizawa
- Department of Thoracic, Endocrine Surgery, and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Shinji Shinohara
- The Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Fumitsugu Kojima
- Department of Thoracic Surgery, St Luke's International Hospital, Tokyo, Japan
| | - Akira Sakurada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan
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Skondras E, Basiony M, Anikin V. Migration of a nodule localisation marker to the contralateral lung. BJR Case Rep 2021; 7:20210017. [PMID: 35136624 PMCID: PMC8803240 DOI: 10.1259/bjrcr.20210017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 11/05/2022] Open
Abstract
Video-assisted thoracoscopic surgery (VATS) has been increasingly used to resect lung nodules avoiding thoracotomy thus reducing morbidity and hospitalisation time. One of the main challenges is to localise the target, because very often they are not palpable and small. Various nodule localisation techniques have been used to assist VATS resection including metallic marker implantation adjacent to the lesion of interest. These markers have been known to migrate, more often in the pleural space. We report an unusual case of metallic marker migration to the contralateral lung.
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Affiliation(s)
- Evangelos Skondras
- Department of Radiology, Harefield Hospital, Royal Brompton & Harefield NHS Trust, London, UK
| | - Mohamed Basiony
- Department of Radiology, Harefield Hospital, Royal Brompton & Harefield NHS Trust, London, UK
| | - Vladimir Anikin
- Department of Thoracic Surgery, Harefield Hospital, Royal Brompton & Harefield NHS Trust, London, UK
- Department of Oncology and Reconstructive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
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Li CD, Huang ZG, Sun HL, Wang LT, Wang YL. CT-guided preoperative localization of ground glass nodule: comparison between the application of embolization microcoil and the locating needle designed for pulmonary nodules. Br J Radiol 2021; 94:20210193. [PMID: 34111980 DOI: 10.1259/bjr.20210193] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To compare the efficacy and safety of pre-operative localization of ground glass nodule (GGN) using embolization microcoils and the locating needles designed for pulmonary nodules. METHODS From June 2019 to December 2020, 429 patients who received CT-guided localization of single GGN before video-assisted thoracoscopic surgery (VATS) were enrolled. The diameter and depth of GGNs were 0.84 ± 0.39 cm and 1.66 ± 1.37 cm. Among 429 cases, the first 221 GGNs were marked with microcoils (the microcoil group), and the remaining 208 GGNs were marked with the locating needles designed for pulmonary nodules (the locating needle group). SPSS 17.0 statistical software was used to compare the marking success rate, marking time, marking-related complications between two groups. p values < 0.05 were considered statistically significant. RESULTS The marking time in the microcoil group was longer than that in the locating needle group (11.1 ± 3.9 vs 8.2 ± 2.0 min, t = -7.87, p = 0.000). The marking success rate in the microcoil group was lower than that in the locating needle group (91.4% vs 98.6%, χ2 = 11.27, p = 0.001). In the microcoil group, marking failures included 16 cases of microcoil dislocation and 3 cases of unsatisfactory microcoil position, while all 3 cases of marking failure in the locating needle group were due to unsatisfactory anchor position. No significant differences in the incidence of total complications (23.1% vs 22.1%), pneumothorax (18.1% vs 19.2%), hemorrhage (9.5% vs 9.1%), and hemoptysis (1.8% vs 1.4%) were observed between the two groups. All the complications were minor and did not need special treatment. Except for one case in the microcoil group, which was converted to thoracotomy, the remaining 428 GGNs were successfully resected by VATS. CONCLUSIONS It is safe and effective to perform pre-operative localization of GGN using either embolization microcoil or the locating needle designed for pulmonary nodules. The locating needle is superior to microcoil for marking GGN in terms of procedure time and the success rate. The complication rate of both methods is similar. ADVANCES IN KNOWLEDGE The locating needle designed for pulmonary nodules has recently been used to mark pulmonary nodule. Its structure can effectively avoid dislocation after localization, and the marking process is simple and quick. Compared with localization using microcoil, it takes less time and has higher success rate to mark GGNs using the locating needle. The complication rate of both methods is similar.
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Affiliation(s)
- Chuan-Dong Li
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Zhen-Guo Huang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Hong-Liang Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Li-Tao Wang
- Department of oncology comprehensive treatment, The Second Hospital of Chifeng, Inner Mongolia, China
| | - Yu-Li Wang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
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Xu Y, Ma L, Lin J, Sun H, Huang Z, Zhang Z, Xiao F, Ma Q. CT-guided microcoil localization for pulmonary nodules in the scapula-shadowed area before Video-Assisted Thoracic Surgery. CLINICAL RESPIRATORY JOURNAL 2021; 15:897-903. [PMID: 33866688 DOI: 10.1111/crj.13379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the feasibility and safety of CT-guided microcoil localization for pulmonary nodules in the scapula-shadowed area before video-assisted thoracic surgery (VATS). MATERIALS AND METHODS Forty-seven patients (18 males, 19 females; mean age 57.5 years) with 48 pulmonary nodules covered by the scapulae were consecutively enrolled in this study. Successful targeting, localization, and VATS were defined as implantation of microcoil at the target site on CT image obtained immediately after the marking procedure, visualization of nodule location during VATS, and complete resection of the target nodule with adequate margin, respectively. Meanwhile, the procedure-related complication rate was also recorded. RESULTS The rates of successful targeting and localization were 95.8% (46/48) and 89.6% (43/48), respectively. Of all nodules, 47 were successfully resected with VATS (30 wedge resections; 17 anatomic resections) and 1 nodule was converted to open thoracotomy for diffuse pleural adhesion, thus the successful VATS rate was 97.9% (47/48). With respect to procedure-related complications, only minor complications (including localized pneumothorax and intrapulmonary hemorrhage) were developed and the rate of overall procedure-related complications was 37.5% (18/48), including minor pneumothorax developed in 15 of 48 nodules (31.3%) and intrapulmonary hemorrhage in 6 of 48 nodules (12.5%). CONCLUSIONS CT-guided microcoil technique is a safe and effective localization method prior to VATS for the nodules in the scapula-shadowed area.
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Affiliation(s)
- Yanyan Xu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Lingchuan Ma
- Department of Radiology, The People's Hospital of Wenshan Prefecture, Wenshan, China
| | - Jie Lin
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Hongliang Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Zhenguo Huang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Zhenrong Zhang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Fei Xiao
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Qianli Ma
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
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Lee MO, Jin SY, Lee SK, Hwang S, Kim TG, Song YG. Video-assisted thoracoscopic surgical wedge resection using multiplanar computed tomography reconstruction-fluoroscopy after CT guided microcoil localization. Thorac Cancer 2021; 12:1721-1725. [PMID: 33943015 PMCID: PMC8169305 DOI: 10.1111/1759-7714.13968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND When early-stage lung cancer is diagnosed, the recommended treatment is anatomical resection using video-assisted thoracoscopic surgery (VATS) or robotic lobectomy. However, nonanatomical resection, known as wedge resection (WR), which is performed to diagnose pulmonary nodules, can be problematic for clinicians performing VATS or robotic-assisted thoracic surgery (RATS). The purpose of this study was to evaluate the safety and effectiveness of VATS WR using multiplanar computed tomography reconstruction (CT MPR)-fluoroscopy after CT guided microcoil localization to achieve complete pulmonary nodule resection. METHODS Between January 2016 to December 2020, the medical records of patients who underwent CT-guided microcoil localization for suspicious malignant pulmonary nodules and VATS WR with CT MPR and intraoperative fluoroscopy were retrospectively reviewed. RESULTS All 130 patients successfully underwent CT-guided localization. The success rate of VATS WR with CT MPR-intraoperative fluoroscopy was 98.5%. Mean operation time was 58 min (range 50-84 min). The postoperative complication rate was 3.1%, and no major postoperative complications were reported. The mean postoperative length of hospital stay was 4.7 days (range 4-8 days). CONCLUSIONS VATS WR using CT MPR-fluoroscopy after CT guided microcoil localization is a safe and highly effective approach for complete pulmonary nodule resection. However, even in uniport VATS or recently performed robotic surgery, localization and resection of nonvisible, nonpalpable pulmonary nodules is a challenging problem. Consequently, satisfactory outcomes can be expected if this technique is used for suspicious malignant pulmonary nodule resection.
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Affiliation(s)
- Moon Ok Lee
- Department of Anesthesia and Pain Medicine, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Sung Yup Jin
- Department of Anesthesia and Pain Medicine, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Sang Kyung Lee
- Department of Anesthesia and Pain Medicine, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Sangwon Hwang
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Tae Gyu Kim
- Department of Radiation Oncology, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Yun Gyu Song
- Department of Radiology Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
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Huang ZG, Wang CL, Sun HL, Li CD, Gao BX, Chen H, Yang MX. CT-Guided Microcoil Localization of Small Peripheral Pulmonary Nodules to Direct Video-Assisted Thoracoscopic Resection without the Aid of Intraoperative Fluoroscopy. Korean J Radiol 2021; 22:1124-1131. [PMID: 33856129 PMCID: PMC8236367 DOI: 10.3348/kjr.2020.0331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 11/21/2020] [Accepted: 12/01/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility, safety, and effectiveness of CT-guided microcoil localization of solitary pulmonary nodules (SPNs) for guiding video-assisted thoracoscopic surgery (VATS). MATERIALS AND METHODS Between June 2016 and October 2019, 454 consecutive patients with 501 SPNs who received CT-guided microcoil localization before VATS in our institution were enrolled. The diameter of the nodules was 0.93 ± 0.49 cm, and the shortest distance from the nodules to the pleura was 1.41 ± 0.95 cm. The distal end of the microcoil was placed less than 1 cm away from the nodule, and the proximal end was placed outside the visceral pleura. VATS was performed under the guidance of implanted microcoils without the aid of intraoperative fluoroscopy. RESULTS All 501 nodules were marked with microcoils. The time required for microcoil localization was 12.8 ± 5.2 minutes. Microcoil localization-related complications occurred in 179 cases (39.4%). None of the complications required treatment. A total of 463 nodules were successfully resected under the guidance of implanted microcoils. VATS revealed 38 patients with dislocated microcoils, of which 28 underwent wedge resection (21 cases under the guidance of the bleeding points of pleural puncture, 7 cases through palpation), 5 underwent direct lobectomy, and the remaining 5 underwent a conversion to thoracotomy. In 4 cases, a portion of the microcoil remained in the lung parenchyma. CONCLUSION CT-guided microcoil localization of SPNs is safe and reliable. Marking the nodule and pleura simultaneously with microcoils can effectively guide the resection of SPNs using VATS without the aid of intraoperative fluoroscopy.
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Affiliation(s)
- Zhen Guo Huang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China.
| | - Cun Li Wang
- Department of Radiology, Baotou Third Hospital, Baotou, the Inner Mongolia Autonomous Region, China
| | - Hong Liang Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Chuan Dong Li
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Bao Xiang Gao
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - He Chen
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Min Xing Yang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
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Xu Y, Ma L, Sun H, Huang Z, Zhang Z, Xiao F, Ma Q, Lin J, Xie S. The utility of simultaneous CT-guided localization for multiple pulmonary nodules using microcoil before video-assisted thoracic surgery. BMC Pulm Med 2021; 21:39. [PMID: 33494732 PMCID: PMC7831238 DOI: 10.1186/s12890-021-01393-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 01/01/2021] [Indexed: 12/21/2022] Open
Abstract
Background To evaluate the feasibility and safety of microcoil in simultaneous localization for multiple pulmonary nodules before video-assisted thoracic surgery (VATS). Methods Twenty-eight consecutive patients (26 two-nodule, 2 three-nodule; 58 nodules in total; Group A) underwent simultaneous CT-guided localization of multiple pulmonary nodules before VATS using microcoil. Successful targeting, localization, and VATS were defined as implantation of microcoil at the target site on CT image which was obtained immediately after the marking procedure, visualization of nodule location, and complete resection of the target nodule with adequate margin, respectively. Meanwhile, the clinical characteristics, localization procedure-related variables of the nodules and procedure-related complications in group A were also assessed and compared with those in a control group (221 single-localization procedures in 221 patients; Group B). Results Similar rates of successful targeting, localization and VATS were observed in group A and B (96.6% vs. 98.2%; 91.4% vs. 91.0%; 100% vs. 99.1%). Although the rate of overall complications (including localized pneumothorax and intrapulmonary hemorrhage) was a bit higher in group A than that in group B (32.8% vs. 30.8%, p = 0.771), only minor complications were observed in the subjects of the two groups with no need for further treatment. In addition, the duration of simultaneous localization procedures was significantly longer than that of single localization (24 ± 7.5 vs.13 ± 6 min, p < 0.001). Conclusions CT-guided simultaneous microcoil localization for multiple pulmonary nodules before VATS was clinically feasible and safe with acceptable increase in the procedure time. Compared with localization for a single pulmonary nodule, simultaneous microcoil localizations for multiple nodules were prone to pneumothorax and hemorrhage. However, no statistically significant differences were observed between the two groups.
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Affiliation(s)
- Yanyan Xu
- Department of Radiology, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Lingchuan Ma
- Department of Radiology, The People's Hospital of Wenshan Prefecture, Wenshan, 663099, China
| | - Hongliang Sun
- Department of Radiology, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China.
| | - Zhenguo Huang
- Department of Radiology, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Zhenrong Zhang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Fei Xiao
- Department of Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Qianli Ma
- Department of Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Jie Lin
- Department of Pathology, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
| | - Sheng Xie
- Department of Radiology, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China
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Commentary: Evolving clinical value of pulmonary nodule image-guided localization technology for the thoracoscopic surgeon. JTCVS Tech 2020; 3:336-337. [PMID: 34317921 PMCID: PMC8305741 DOI: 10.1016/j.xjtc.2020.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 11/28/2022] Open
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Sun S, Liu K, Gao X, Ren B, Sun L, Xu L. Application of Modified Tailed Microcoil in Preoperative Localization of Small Pulmonary Nodules: A Retrospective Study. Thorac Cardiovasc Surg 2020; 68:533-539. [PMID: 32559810 DOI: 10.1055/s-0040-1708471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The localization of small pulmonary nodules (SPNs) during video-assisted thoracoscopic surgery (VATS) is challenging thoracic surgeon, especially in patients with severe pleural adhesion or visceral pleura pigmentation due to low success rate and future conversion to thoracotomy. This study aims to compare the efficacy and safety between modified microcoil and methylene blue in preoperative localization of small nodules, particularly patients with severe pleural adhesion or visceral pleura pigmentation. MATERIALS AND METHODS From January 2018 to February 2019 in our institute, 342 patients who underwent computed tomography-guided localization of SPN were recruited in this retrospective cohort study and divided into the modified microcoil group (n = 239) and the methylene blue group (n = 103) according to the localization method. Clinical characteristics and perioperative complications were collected to analyze. RESULTS All SPNs were successfully marked in both groups. Location-related complications, the duration of localization procedure, and the length of hospital stay were not different between the two groups. The operation time of modified microcoil and the duration of removal of nodule in operation were both shorter than the methylene blue (p = 0.014 and p = 0.047). The analysis stratified by gender showed that similar results were found in male patients (p = 0.01 and p = 0.00), while in female patients, no significant difference was found. Additionally, in senior patients (older than 60 years), the operation time in modified microcoil groups was less than methylene blue group (p = 0.024). CONCLUSION Compared with methylene blue, modified microcoil achieved a shorter operation time of removal of nodule in VATS, especially for patients with pleural adhesion and the pigmentation of the lung surface as well as the male patients and the patients older than 60 years.
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Affiliation(s)
- Saisai Sun
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Kaichao Liu
- Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Xiang Gao
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Binhui Ren
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lei Sun
- Department of Interventional Radiology, Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lin Xu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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CT-guided microcoil localization for pulmonary nodules before VATS: a retrospective evaluation of risk factors for pleural marking failure. Eur Radiol 2020; 30:5674-5683. [PMID: 32458172 DOI: 10.1007/s00330-020-06954-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/03/2020] [Accepted: 05/13/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To summarize the experiences of CT-guided microcoil localization before video-assisted thoracoscopic surgery (VATS) and to investigate the risk factors associated with pleural marking failure. METHODS Totally, 249 consecutive patients with 279 pulmonary nodules who underwent CT-guided microcoil localization prior to VATS were enrolled in this study. According to intraoperative observation, all the nodules were divided into two groups. The clinical characteristics and microcoil localization procedure-related variables of the nodules were analyzed by univariate analysis and multivariate logistic regression analysis to screen the independent factors associated with procedure results. RESULTS Among the 279 nodules, 28 failed to observe the proximal end of the microcoil deployed on visceral pleura during VATS. The logistic regression revealed that needle-pleura angle (≤ 30°: OR = 39.022, p = 0.003), pleura-microcoil distance (≤ 10 mm: OR = 87.054, p < 0.001; 10~20 mm: OR = 10.088, p = 0.010), and presence of pleural indentation (OR = 21.623, p < 0.001) were independent risk factors for pleural marking failure. CONCLUSIONS CT-guided microcoil localization for pulmonary nodules is a safe and effective procedure. Small needle-pleura angle (≤ 30°), pleura-microcoil distance (≤ 20 mm), and the presence of pleural indentation during the procedure are significant risk factors contributing to microcoil pleura marking failure. KEY POINTS • CT-guided microcoil localization for pulmonary nodules was a safe and effective procedure. • CT-guided microcoil localization for pulmonary nodules yielded low complication rates. • Small needle-pleura angle, short pleura-microcoil distance, and the presence of pleural indentation were contributing to pleura marking failure.
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Liu C, Zhao L, Wu F, Feng Y, Jiang R, Hu C. The multidisciplinary team plays an important role in the prediction of small solitary pulmonary nodules: a propensity-score-matching study. ANNALS OF TRANSLATIONAL MEDICINE 2020; 7:740. [PMID: 32042756 DOI: 10.21037/atm.2019.11.125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background According to guidelines, it is recommended that pulmonary nodules be discussed by a multidisciplinary team (MDT); however, the evidence for the effectiveness of MDT is sparse. To demonstrate the importance of the involvement of an MDT for the prediction of small solitary pulmonary nodules, we conducted this retrospective study. Methods The patient database of those who attended our MDT and the electronic medical record system of our hospital was used; we collected all the data from patients found with small solitary pulmonary nodules (≤2 cm), which were suspected as malignant and who received a resection of the nodules. We summarized their characteristics and analyzed them, and then compared the post-operation pathological diagnosis of the patients who attended an MDT to those who did not participate in an MDT during the same period (2017-2019.2). We also collected the follow-up data. Propensity-score-matching was utilized during the process of analysis to get a more reliable conclusion. Results Most of the qualified patients were female. Most of the small solitary pulmonary nodules (≤2 cm) were adenocarcinoma and located on the right upper lobe. There were no differences in the SUV value between malignant nodules and benign nodules. After propensity-score matching, the total positive prediction value of small solitary pulmonary nodules (≤2 cm) without an MDT was 69.4%, while that with MDT was 77.6%; the difference was not significant with a P value of 0.30. The negative predictive value of MDT was 76.2%. Conclusions In developing countries, small solitary pulmonary nodules tend to be more correctly diagnosed with MDT.
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Affiliation(s)
- Chaoyuan Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Lishu Zhao
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Fang Wu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Yeqian Feng
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Rong Jiang
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Chunhong Hu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
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Refai M, Andolfi M, Barbisan F, Roncon A, Guiducci GM, Xiumè F, Salati M, Tiberi M, Giovagnoni A, Paci E. Computed tomography-guided microcoil placement for localizing small pulmonary nodules before uniportal video-assisted thoracoscopic resection. Radiol Med 2019; 125:24-30. [DOI: 10.1007/s11547-019-01077-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/04/2019] [Indexed: 12/19/2022]
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25
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Computed tomography–guided platinum microcoil lung surgery: A cross-sectional study. J Thorac Cardiovasc Surg 2019; 158:594-600. [DOI: 10.1016/j.jtcvs.2019.03.096] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/04/2019] [Accepted: 03/10/2019] [Indexed: 11/20/2022]
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Kothapalli PR, Wyler von Ballmoos MC, Chinnadurai P, Lumsden AB, Ramchandani MK. Value of the Hybrid Operating Theater for an Integrated Approach to Diagnosis and Treatment of Pulmonary Nodules in 2019. Front Surg 2019; 6:36. [PMID: 31316994 PMCID: PMC6610426 DOI: 10.3389/fsurg.2019.00036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 06/03/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Priya R Kothapalli
- Department of Cardiothoracic Surgery, DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, United States.,Weill Cornell Medicine, New York, NY, United States
| | - Moritz C Wyler von Ballmoos
- Department of Cardiothoracic Surgery, DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, United States.,Weill Cornell Medicine, New York, NY, United States
| | - Ponraj Chinnadurai
- Department of Cardiothoracic Surgery, DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, United States.,Advanced Therapies, Siemens Medical Solutions Inc., Malvern, PA, United States
| | - Alan B Lumsden
- Department of Cardiothoracic Surgery, DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, United States.,Weill Cornell Medicine, New York, NY, United States
| | - Mahesh K Ramchandani
- Department of Cardiothoracic Surgery, DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, United States.,Weill Cornell Medicine, New York, NY, United States
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Rodrigues JCL, Pierre AF, Hanneman K, Cabanero M, Kavanagh J, Waddell TK, Chung TB, Pakkal M, Keshavjee S, Cypel M, Yasufuku K, Nguyen ET. CT-guided Microcoil Pulmonary Nodule Localization prior to Video-assisted Thoracoscopic Surgery: Diagnostic Utility and Recurrence-Free Survival. Radiology 2019; 291:214-222. [PMID: 30720402 DOI: 10.1148/radiol.2019181674] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background CT-guided microcoil localization has been shown to reduce the need for thoracotomy or video-assisted thoracoscopic surgery (VATS) anatomic resection. However, only short-term follow-up after CT-guided microcoil localization and lung resection has been previously reported. Purpose To assess the diagnostic utility and recurrence-free survival over a minimum of 2 years following CT-guided microcoil localization and VATS. Materials and Methods Among 1950 VATS procedures performed in a single tertiary institution from October 2008 through April 2016, 124 consecutive patients with CT-guided microcoil localization were retrospectively evaluated. Patient demographics, nodule characteristics, and histopathologic findings were recorded. The primary end point was recurrence-free survival after 2 or more years of CT surveillance. Statistical analysis included Kaplan-Meier survival curves and Cox regression. Results In 124 patients (men, 35%; mean age, 65 years ± 12) with a nodule found at CT, microcoil localization and VATS resection were performed for a total of 126 nodules (mean size, 13 mm ± 6; mean distance to pleura, 20 mm ± 9). On presurgical CT evaluation, 42% (53 of 126) of nodules were solid, 33% (41 of 126) were ground glass, and 24% (30 of 126) were subsolid. VATS excisional biopsy altered cytopathologic diagnosis in 21% (five of 24) of patients with prior diagnostic premicrocoil CT-guided biopsy. At histopathologic examination, 17% (21 of 126) of the nodules were adenocarcinoma in situ, 17% (22 of 126) were minimally invasive adenocarcinoma, 30% (38 of 126) were invasive lung primary tumors, and 22% (28 of 126) were metastases. Among the 72 patients with malignancy at histopathologic examination and at least 2 years of CT surveillance, local recurrence occurred in 7% (five of 72), intrathoracic recurrence in 22% (16 of 72), and extrathoracic recurrence in 18% (13 of 72) after 2 or more years of CT surveillance. There was no recurrence for adenocarcinoma in situ, minimally invasive adenocarcinoma, or invasive lung tumors measuring less than 1 cm. After multivariable adjustment, nodule location at a distance greater than 10 mm from the pleura was an independent predictor of time to recurrence (hazard ratio, 2.9 [95% confidence interval: 1.1, 7.4]; P = .03). Conclusion CT-guided microcoil localization and video-assisted thoracoscopic surgical resection alter clinical management and were associated with excellent recurrence-free survival for superficial premalignant, minimally invasive, and small invasive lung tumors. © RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- Jonathan C L Rodrigues
- From the Divisions of Cardiothoracic Imaging (J.C.L.R., K.H., J.K., T.B.C., M.P., E.T.N.), Thoracic Surgery (A.F.P., T.K.W., S.K., M.C., K.Y.), and Thoracic Pathology (M.C.), Toronto General Hospital, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2; Postgraduate Medical Education, Department of Medical Imaging, University of Toronto, Toronto, Canada (J.C.L.R.); and Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, England, United Kingdom, BA1 3NG (J.C.L.R.)
| | - Andrew F Pierre
- From the Divisions of Cardiothoracic Imaging (J.C.L.R., K.H., J.K., T.B.C., M.P., E.T.N.), Thoracic Surgery (A.F.P., T.K.W., S.K., M.C., K.Y.), and Thoracic Pathology (M.C.), Toronto General Hospital, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2; Postgraduate Medical Education, Department of Medical Imaging, University of Toronto, Toronto, Canada (J.C.L.R.); and Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, England, United Kingdom, BA1 3NG (J.C.L.R.)
| | - Kate Hanneman
- From the Divisions of Cardiothoracic Imaging (J.C.L.R., K.H., J.K., T.B.C., M.P., E.T.N.), Thoracic Surgery (A.F.P., T.K.W., S.K., M.C., K.Y.), and Thoracic Pathology (M.C.), Toronto General Hospital, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2; Postgraduate Medical Education, Department of Medical Imaging, University of Toronto, Toronto, Canada (J.C.L.R.); and Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, England, United Kingdom, BA1 3NG (J.C.L.R.)
| | - Michael Cabanero
- From the Divisions of Cardiothoracic Imaging (J.C.L.R., K.H., J.K., T.B.C., M.P., E.T.N.), Thoracic Surgery (A.F.P., T.K.W., S.K., M.C., K.Y.), and Thoracic Pathology (M.C.), Toronto General Hospital, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2; Postgraduate Medical Education, Department of Medical Imaging, University of Toronto, Toronto, Canada (J.C.L.R.); and Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, England, United Kingdom, BA1 3NG (J.C.L.R.)
| | - John Kavanagh
- From the Divisions of Cardiothoracic Imaging (J.C.L.R., K.H., J.K., T.B.C., M.P., E.T.N.), Thoracic Surgery (A.F.P., T.K.W., S.K., M.C., K.Y.), and Thoracic Pathology (M.C.), Toronto General Hospital, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2; Postgraduate Medical Education, Department of Medical Imaging, University of Toronto, Toronto, Canada (J.C.L.R.); and Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, England, United Kingdom, BA1 3NG (J.C.L.R.)
| | - Thomas K Waddell
- From the Divisions of Cardiothoracic Imaging (J.C.L.R., K.H., J.K., T.B.C., M.P., E.T.N.), Thoracic Surgery (A.F.P., T.K.W., S.K., M.C., K.Y.), and Thoracic Pathology (M.C.), Toronto General Hospital, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2; Postgraduate Medical Education, Department of Medical Imaging, University of Toronto, Toronto, Canada (J.C.L.R.); and Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, England, United Kingdom, BA1 3NG (J.C.L.R.)
| | - Tae-Bong Chung
- From the Divisions of Cardiothoracic Imaging (J.C.L.R., K.H., J.K., T.B.C., M.P., E.T.N.), Thoracic Surgery (A.F.P., T.K.W., S.K., M.C., K.Y.), and Thoracic Pathology (M.C.), Toronto General Hospital, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2; Postgraduate Medical Education, Department of Medical Imaging, University of Toronto, Toronto, Canada (J.C.L.R.); and Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, England, United Kingdom, BA1 3NG (J.C.L.R.)
| | - Mini Pakkal
- From the Divisions of Cardiothoracic Imaging (J.C.L.R., K.H., J.K., T.B.C., M.P., E.T.N.), Thoracic Surgery (A.F.P., T.K.W., S.K., M.C., K.Y.), and Thoracic Pathology (M.C.), Toronto General Hospital, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2; Postgraduate Medical Education, Department of Medical Imaging, University of Toronto, Toronto, Canada (J.C.L.R.); and Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, England, United Kingdom, BA1 3NG (J.C.L.R.)
| | - Shaf Keshavjee
- From the Divisions of Cardiothoracic Imaging (J.C.L.R., K.H., J.K., T.B.C., M.P., E.T.N.), Thoracic Surgery (A.F.P., T.K.W., S.K., M.C., K.Y.), and Thoracic Pathology (M.C.), Toronto General Hospital, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2; Postgraduate Medical Education, Department of Medical Imaging, University of Toronto, Toronto, Canada (J.C.L.R.); and Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, England, United Kingdom, BA1 3NG (J.C.L.R.)
| | - Marcelo Cypel
- From the Divisions of Cardiothoracic Imaging (J.C.L.R., K.H., J.K., T.B.C., M.P., E.T.N.), Thoracic Surgery (A.F.P., T.K.W., S.K., M.C., K.Y.), and Thoracic Pathology (M.C.), Toronto General Hospital, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2; Postgraduate Medical Education, Department of Medical Imaging, University of Toronto, Toronto, Canada (J.C.L.R.); and Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, England, United Kingdom, BA1 3NG (J.C.L.R.)
| | - Kazuhiro Yasufuku
- From the Divisions of Cardiothoracic Imaging (J.C.L.R., K.H., J.K., T.B.C., M.P., E.T.N.), Thoracic Surgery (A.F.P., T.K.W., S.K., M.C., K.Y.), and Thoracic Pathology (M.C.), Toronto General Hospital, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2; Postgraduate Medical Education, Department of Medical Imaging, University of Toronto, Toronto, Canada (J.C.L.R.); and Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, England, United Kingdom, BA1 3NG (J.C.L.R.)
| | - Elsie T Nguyen
- From the Divisions of Cardiothoracic Imaging (J.C.L.R., K.H., J.K., T.B.C., M.P., E.T.N.), Thoracic Surgery (A.F.P., T.K.W., S.K., M.C., K.Y.), and Thoracic Pathology (M.C.), Toronto General Hospital, University Health Network, 585 University Ave, Toronto, ON, Canada M5G 2N2; Postgraduate Medical Education, Department of Medical Imaging, University of Toronto, Toronto, Canada (J.C.L.R.); and Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, England, United Kingdom, BA1 3NG (J.C.L.R.)
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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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Dailey WA, Frey GT, McKinney JM, Paz-Fumagalli R, Sella DM, Toskich BB, Thomas M. Percutaneous Computed Tomography-Guided Radiotracer-Assisted Localization of Difficult Pulmonary Nodules in Uniportal Video-Assisted Thoracic Surgery. J Laparoendosc Adv Surg Tech A 2018; 28:1451-1457. [PMID: 29979620 DOI: 10.1089/lap.2018.0248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To report our institutional experience with radiotracer-assisted localization of lung nodules (RALN) in combination with uniportal video-assisted thoracoscopic surgery (UVATS). Methods: We retrospectively reviewed electronic medical records and radiology images of 27 consecutive adult patients who underwent planned UVATS lung resections combined with RALN from January 2014 to May 2017. Based on preoperative imaging, 29 nondescript nodules were marked with technetium 99 m macroaggregated albumin under computed tomography guidance before resection. Perioperative outcomes were analyzed. Results: All 29 nodules were successfully marked and resected with negative margins by UVATS; 12 (41.5%) were pure ground-glass opacities. Three patients had prior ipsilateral lung resections. There were no conversions to multiport VATS or thoracotomy. The majority (86.5%) of the nodules were malignant. The median nodule size was 8 mm (range: 3-20 mm) and depth, 56 mm (range: 22-150 mm). The majority (21/27; 77.8%) of patients underwent wedge resections alone, while 6 patients had anatomical resections. Median times were as follows: radiotracer injection to surgery, 219 minutes (range: 139-487 minutes); operative time, 85.5 minutes (32-236 minutes); chest tube removal, 1 day (range: 1-2 days); and length of stay, 2 days (range: 1-4 days). Four patients (14.8%) had a pigtail catheter placed for pneumothorax after radiotracer injection. One patient was readmitted 1 week after discharge for a spontaneous pneumothorax. There were no other morbidities or any 90-day mortality. Conclusion: RALN can be combined with UVATS to effectively resect small, deep, or low-density lung lesions that are difficult to visualize or palpate by thoracoscopy.
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Affiliation(s)
| | - Gregory T Frey
- 2 Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - J Mark McKinney
- 2 Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | | | - David M Sella
- 2 Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Beau B Toskich
- 2 Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Mathew Thomas
- 3 Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
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Liu Z, Zhang Z, Chen C, Hong N. Value of virtual monochromatic spectral images with metal artifact reduction algorithm in dual-energy computed tomography-guided microcoil localization of pulmonary nodules. Medicine (Baltimore) 2018; 97:e11562. [PMID: 30024555 PMCID: PMC6086503 DOI: 10.1097/md.0000000000011562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
To evaluate the clinical value of virtual monochromatic spectral (VMS) images with metal artifact reduction (MAR) algorithm in dual-energy computed tomography (DECT)-guided microcoil localization of pulmonary nodules.Fifty-one patients underwent DECT after placement of microcoils on small pulmonary nodules before video-assisted thoracoscopic surgery (VATS). Optimal energy level (in keV) was defined as the level at which CT values of nodules were equivalent to those of 120 kVp images and with no serious metal artifacts. VMS images at optimal keV and at 50, 90,110, and 140 keV with and without MAR were reconstructed. Image quality was scored using a 3-point scale: 1 = excellent, minimal artifacts; 2 = good, mild artifacts; and 3 = poor, extensive artifacts. Image quality scores between the VMS-only and VMS + MAR groups were compared;74 keV was found to be the optimal level for VMS images. The image quality of the VMS + MAR images at 74 keV were significantly better than VMS-only images (1.35 ± 0.59 vs 2.11 ± 0.87, P = .005). There was no difference in image quality score among VMS + MAR images at 74 keV and higher energy levels.VMS images from DECT at 74 keV with MAR can reduce artifacts from microcoils and improve image quality for microcoil localization of pulmonary nodules.
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Nakazawa S, Shimizu K, Mogi A, Kuwano H. VATS segmentectomy: past, present, and future. Gen Thorac Cardiovasc Surg 2017; 66:81-90. [PMID: 29255967 DOI: 10.1007/s11748-017-0878-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/05/2017] [Indexed: 12/12/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) has gradually been implemented in thoracic surgery, and the VATS approach has now been extended to technically challenging procedures, such as segmentectomy. The definition of VATS segmentectomy is changing over time, and the repertoire of segmentectomy is getting wider with increasing reports on atypical segmentectomy. VATS segmentectomy bears surgical, oncological, and technical advantages; however, there are still areas of controversy, particularly regarding oncological outcomes. The indication of VATS segmentectomy is diverse and is used for treating lung cancer, metastatic lung tumors, or a variety of nonmalignant diseases. It is particularly valuable for the lung-sparing resection of deeply located small nodules or repeated surgery for multiple lung lesions. VATS segmentectomy requires a thorough analysis of segmental anatomy and a tailored preoperative planning with the assessment of surgical margins. Technical challenges include intraoperative navigation, methods to identify and dissect the intersegmental plane, and the prevention of air leakage. This review will discuss the present state of VATS segmentectomy, with a focus on past studies, current indications and techniques, and future view.
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Affiliation(s)
- Seshiru Nakazawa
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Akira Mogi
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hiroyuki Kuwano
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Obeso A, Abada H, Souilamas R. Hybrid Procedures for Pulmonary Nodule Resection: The Beginning of a New Era. Arch Bronconeumol 2017; 54:183-184. [PMID: 29246710 DOI: 10.1016/j.arbres.2017.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 10/30/2017] [Accepted: 11/01/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Andrés Obeso
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, Emiratos Árabes Unidos.
| | - Hicham Abada
- Imaging Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, Emiratos Árabes Unidos
| | - Redha Souilamas
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, Emiratos Árabes Unidos
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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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Ujiie H, Effat A, Yasufuku K. Image-guided thoracic surgery in the hybrid operation room. J Vis Surg 2017; 3:148. [PMID: 29302424 DOI: 10.21037/jovs.2017.09.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/15/2017] [Indexed: 11/06/2022]
Abstract
There has been an increase in the use of image-guided technology to facilitate minimally invasive therapy. The next generation of minimally invasive therapy is focused on advancement and translation of novel image-guided technologies in therapeutic interventions, including surgery, interventional pulmonology, radiation therapy, and interventional laser therapy. To establish the efficacy of different minimally invasive therapies, we have developed a hybrid operating room, known as the guided therapeutics operating room (GTx OR) at the Toronto General Hospital. The GTx OR is equipped with multi-modality image-guidance systems, which features a dual source-dual energy computed tomography (CT) scanner, a robotic cone-beam CT (CBCT)/fluoroscopy, high-performance endobronchial ultrasound system, endoscopic surgery system, near-infrared (NIR) fluorescence imaging system, and navigation tracking systems. The novel multimodality image-guidance systems allow physicians to quickly, and accurately image patients while they are on the operating table. This yield improved outcomes since physicians are able to use image guidance during their procedures, and carry out innovative multi-modality therapeutics. Multiple preclinical translational studies pertaining to innovative minimally invasive technology is being developed in our guided therapeutics laboratory (GTx Lab). The GTx Lab is equipped with similar technology, and multimodality image-guidance systems as the GTx OR, and acts as an appropriate platform for translation of research into human clinical trials. Through the GTx Lab, we are able to perform basic research, such as the development of image-guided technologies, preclinical model testing, as well as preclinical imaging, and then translate that research into the GTx OR. This OR allows for the utilization of new technologies in cancer therapy, including molecular imaging, and other innovative imaging modalities, and therefore enables a better quality of life for patients, both during and after the procedure. In this article, we describe capabilities of the GTx systems, and discuss the first-in-human technologies used, and evaluated in GTx OR.
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Affiliation(s)
- Hideki Ujiie
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andrew Effat
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
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Stanzi A, Mazza F, Lucio F, Ghirardo D, Grosso M, Locatelli A, Melloni G. Tailored intraoperative localization of non-palpable pulmonary lesions for thoracoscopic wedge resection using hybrid room technology. CLINICAL RESPIRATORY JOURNAL 2017; 12:1661-1667. [PMID: 29028153 DOI: 10.1111/crj.12725] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/31/2017] [Accepted: 10/08/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION VATS wedge resection can require conversion to thoracotomy when pulmonary lesions cannot be identified. Hybrid operating rooms (HORs) provide real-time image acquisition capabilities allowing the intraoperative placement of markers to facilitate the removal of non-palpable nodules during VATS. OBJECTIVES To present our workflow based on the alternative use of two different markers according to the location of the lung lesion and report our initial results. METHODS All consecutive patients with non-palpable lesions requiring VATS wedge resection underwent localization of the targets in HOR. Lesions were considered non-palpable if they were small (<1 cm), deep (>1 cm from surface), subsolid, or located within a dystrophic area. Anesthetized patients were placed in lateral decubitus. Cone-beam CT (CBCT) was performed, and the needle trajectory was planned using Syngo iGuide Needle Guidance. Metal hook-wire or coil was placed, according to our workflow, close to the lesion and their position was verified by CBCT or fluoroscopy. RESULTS Eleven VATS wedge resections were performed in 10 patients with 12 non-palpable lesions. The localization was performed with seven hook-wires and four coils in 30 minutes (range 17-56 minutes). The median estimated total effective dose was 11.6 mSv (range 1.9-24.7 mSv). Eleven lesions were removed by VATS, and one deep nodule required a thoracotomy. No complications were observed. CONCLUSIONS Our experience confirms that HOR is suitable for simultaneous localization and VATS resection of 'difficult' pulmonary lesions. A versatile approach, using different devices, seems advisable for the removal of targets in every clinical scenario, reducing the VATS conversion rate.
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Affiliation(s)
- Alessia Stanzi
- Department of Thoracic Surgery, Santa Croce e Carle General Hospital, Cuneo, Italy
| | - Federico Mazza
- Department of Thoracic Surgery, Santa Croce e Carle General Hospital, Cuneo, Italy
| | - Francesco Lucio
- Medical Physics Department, Santa Croce e Carle General Hospital, Cuneo, Italy
| | - Donatella Ghirardo
- Department of Radiology, Santa Croce e Carle General Hospital, Cuneo, Italy
| | - Maurizio Grosso
- Department of Radiology, Santa Croce e Carle General Hospital, Cuneo, Italy
| | - Alessandro Locatelli
- Department of Anesthesia and Intensive Care, Santa Croce e Carle General Hospital, Cuneo, Italy
| | - Giulio Melloni
- Department of Thoracic Surgery, Santa Croce e Carle General Hospital, Cuneo, Italy
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A novel minimally invasive near-infrared thoracoscopic localization technique of small pulmonary nodules: A phase I feasibility trial. J Thorac Cardiovasc Surg 2017; 154:702-711. [DOI: 10.1016/j.jtcvs.2017.03.140] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 02/12/2017] [Accepted: 03/06/2017] [Indexed: 11/22/2022]
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