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Objectives Hybrid operating rooms have been increasingly used for image-guided lung surgery, and most surgical teams have used percutaneous localisation for small pulmonary nodules. We evaluated the feasibility and safety of augmented fluoroscopic bronchoscopy localisation under endotracheal tube intubation general anaesthesia followed by thoracoscopic surgery as a single-stage procedure in a hybrid operating room. Methods We retrospectively reviewed clinical records of patients who underwent single-stage augmented fluoroscopic bronchoscopy localisation under general anaesthesia followed by thoracoscopic surgery in a hybrid operating room between August 2020 and March 2022. Results Single-stage localisation and resection were performed for 85 nodules in 74 patients. Median nodule size was 8 mm (interquartile range [IQR], 6–9 mm), and median distance from the pleural space was 10.9 mm (IQR, 8–20 mm). All nodules were identifiable on cone-beam computed tomography images and marked transbronchially with indigo carmine dye (median markers per lesion: 3); microcoils were placed for deep margins in 16 patients. Median localisation time was 30 min (IQR 23–42 min), and median fluoroscopy duration was 3.3 min (IQR 2.2–5.3 min). Median radiation exposure (expressed as the dose area product) was 4303.6 μGym2 (IQR 2879.5-6268.7 μGym2). All nodules were successfully marked and resected, and the median global operating room time was 178.5 min (IQR 153.5–204 min). There were no localisation-related complications, and median length of postoperative stay was 1 d (IQR, 1–2 d). Conclusions Single-stage augmented fluoroscopic bronchoscopy localisation under general anaesthesia followed by thoracoscopic surgery was feasible and safe.
Lung cancer is the most lethal cancer type in Taiwan and worldwide. Early detection and treatment advancements have improved survival. However, small peripheral pulmonary nodules (PPN) biopsy is often challenging, relying solely on bronchoscopy with radial endobronchial ultrasound (EBUS). Augmented fluoroscopy overlays the intra-procedural cone-beam computed tomography (CBCT) images with fluoroscopy enabling real-time three-dimensional localization during bronchoscopic transbronchial biopsy. The hybrid operating room (HOR), equipped with various types of C-arm CBCT, is a perfect suite for PPN diagnosis and other interventional pulmonology. This study shares the single institute experience of EBUS transbronchial biopsy of PPN with the aid of augmented fluoroscopic bronchoscopy (AFB) and CBCT in an HOR. We retrospectively enrolled patients who underwent robotic CBCT, augmented fluoroscopy-guided, radial endobronchial ultrasound-confirmed transbronchial biopsy and cryobiopsy in a hybrid operating room. Patient demographic characteristics, computed tomography images, rapid on-site evaluation cytology, and final pathology reports were collected. Forty-one patients underwent transbronchial biopsy and 6 received additional percutaneous transthoracic core-needle biopsy during the same procedure. The overall diagnostic yield was 88%. The complications included three patients with pneumothorax after receiving subsequent CT-guided percutaneous transthoracic needle biopsy, and two patients with hemothorax who underwent transbronchial cryobiopsy. Overall, the bronchoscopic biopsy of PPN using AFB and CBCT as precise guidance in the hybrid operating room is feasible and can be performed safely with a high diagnostic yield.
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