Electromagnetic Navigational Bronchoscopy Reduces the Time Required for Localization and Resection of Lung Nodules

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> The aims of the study were to evaluate electromagnetic navigational bronchoscopy (ENB) and computed tomography–guided placement as localization techniques for minimally invasive resection of small pulmonary nodules and determine whether electromagnetic navigational bronchoscopy is a safer and more effective method than computed tomography–guided localization. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> We performed a retrospective review of our thoracic surgery database to identify patients who underwent minimally invasive resection for a pulmonary mass and used either electromagnetic navigational bronchoscopy or computed tomography–guided localization techniques between July 2011 and May 2015. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Three hundred eighty-three patients had a minimally invasive resection during our study period, 117 of whom underwent electromagnetic navigational bronchoscopy or computed tomography localization (electromagnetic navigational bronchoscopy = 81; computed tomography = 36). There was no significant difference between computed tomography and electromagnetic navigational bronchoscopy patient groups with regard to age, sex, race, pathology, nodule size, or location. Both computed tomography and electromagnetic navigational bronchoscopy were 100% successful at localizing the mass, and there was no difference in the type of definitive surgical resection (wedge, segmentectomy, or lobectomy) ( P = 0.320). Postoperative complications occurred in 36% of all patients, but there were no complications related to the localization procedures. In terms of localization time and surgical time, there was no difference between groups. However, the down/wait time between localization and resection was significant (computed tomography = 189 minutes; electromagnetic navigational bronchoscopy = 27 minutes); this explains why the difference in total time (sum of localization, down, and surgery) was significant ( P &lt; 0.001). </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> We found electromagnetic navigational bronchoscopy to be as safe and effective as computed tomography–guided wire placement and to provide a significantly decreased down time between localization and surgical resection. </jats:p></jats:sec>

Cryobiopsy and dye marking guided by electromagnetic navigation bronchoscopy before resection of pulmonary nodule

“…The pathology diagnosis of malignancy was obtained before VATS in 56% of the patients, thereby preventing the wedge resection otherwise necessary for this diagnosis. On one hand, this proportion is higher than that reported by W. Bolton perprocedural decisional algorithm similar to ours with a transbronchial needle aspiration yielding the peroperative pathology diagnosis in approximately one fourth of the patients [9,20]. On the other hand, this proportion is lower than the two thirds reported in two systematic reviews addressing the performance of ENB-guided forceps biopsy of peripheral lung nodules of any size [21,22].…”

Electromagnetic navigation bronchoscopic dye marking for localization of small subsolid nodules

“…[19,20] Pooled pneumothorax rate in studies using ENB-guided dye marking was 0% and none of the studies reported bronchopulmonary hemorrhage. [6–8,21,22] We also did not experience bronchial hemorrhage nor pneumothorax in 29 dye injections, and ENB procedure did not compromise subsequent thoracoscopic surgery. If any, localization followed immediately by surgery could mitigates adverse effects of potential complications.…”

“…The process and personnel for the transportation of the patient from localization unit to the operation room are not necessary in intraoperative ENB-guided dye marking. Bolton et al [21] reported that ENB-guided localization significantly reduced the waiting time compared with CT-guided localization (27 vs 189 minutes, P = .001).…”

Combined use of the Da Vinci robot system and the LungPoint Virtual Bronchoscopic Navigation system in the management of lung cancer: First Hong Kong experience

“…Injection of lipiodol in addition to the ICG dye allows confirmation of the successful localization as lipiodol could be viewed by fluoroscopy or CT scanning. Compared with CT‐guided localization techniques, there was a less incidence of procedure‐related complications including pulmonary haemorrhage, pneumothorax, haemothorax, haemoptysis and pleural reactions 1–4 . It is important to note that bronchoscopy navigation localization still has limitations in localising those small and centrally located lesions.…”

“…niques, there was a less incidence of procedure-related complications including pulmonary haemorrhage, pneumothorax, haemothorax, haemoptysis and pleural reactions. [1][2][3][4] It is important to note that bronchoscopy navigation localization still has limitations in localising those small and centrally located lesions. These lesions may not be visible under the firefly mode of the robotic system even after the injection of ICG.…”