A novel hybrid technique for localization of subcentimeter lung nodules

Abstract

Background: It is technically challenging to locate non-visible, non-palpable subcentimeter ground-glass nodules (GGNs) of lung during video-assisted thoracic surgery (VATS). Computed tomography (CT)-guided marking of small pulmonary nodules using microcoils has been reported to be a practical method of preoperative localization, whereas dislodgement of microcoils remains to be a bothersome complication. The objective of this study was to assess the viability and effectiveness of a newly developed hybrid technique, which combines induced controllable pneumothorax and CT-guided microcoil marking procedure to reduce the risk of microcoil dislodgement.Methods: After induced minor pneumothorax, 35 patients with subcentimeter GGNs underwent CTguided marking with microcoils prior to VATS sublobar resection or lobectomy. Histopathological analysis was performed after surgeries.Results: All of 37 nodules were successfully marked before VATS. Segmentectomy was performed in 8 cases, wedge resection in 19 cases and lobectomy in 8 cases. All nodules were completely removed with marking microcoils. Dislodgement of microcoils was not observed in all cases and mild pulmonary hemorrhage occurred in one case. No other complications occurred. Conclusions:The newly developed hybrid technique which combines induced controllable pneumothorax and CT-guided marking using microcoils was feasible and reliable for VATS resection of subcentimeter GGNs, meanwhile significantly lowered the risk of microcoil dislocation.Keywords: Video-assisted thoracoscopic surgery; lung nodule; localization; computed tomography (CT); J Thorac Dis 2017;9(4):1107-1112 jtd.amegroups.com established, such as hook-wire or microcoil labelling, intraoperative ultrasound scan, methylene blue staining and radio-guided detection. Among them, CT-guided hookwire or microcoil techniques are preferable due to higher sensitivity, less operator dependence and lower complication rate (3-5). Nevertheless, dislodgment of the wire or coil after the lung collapses in the surgery remains a disturbing problem and leads to a relatively higher failure rate of marking (6). In the current study, we developed a novel hybrid technique, which combines induced controllable pneumothorax and CT-guided microcoil marking, to reduce or even eliminate the risk of dislodgment. MethodsBetween May 2015 and March 2016, 35 patients with 37 subcentimeter lung GGNs who underwent preoperative CT-guided microcoil marking and VATS resections at our institution were retrospectively reviewed. Only subpleural lesions, presumed impalpable, with a maximum distance to the pleural surface of 30mm were included. Lesions were incidentally found in 33 patients while they underwent health examination or were being examined for other medical reasons. In 2 patients with a clinical history of malignancy, the lesions were found during follow-up examination. No preoperative pathologic diagnoses were obtained, either by fiberoptic bronchoscopy (FOB) or by CT-guided needle lung biopsies. Preoperative marking procedureT ...

CT-Guided Microcoil Localization of Small Peripheral Pulmonary Nodules to Direct Video-Assisted Thoracoscopic Resection without the Aid of Intraoperative Fluoroscopy

“…Accurate and effective preoperative or intraoperative localization techniques are helpful for successful wedge resection using VATS. Different materials have been used for the preoperative localization of SPNs [ 11 12 13 14 15 16 17 18 19 ]. Microcoils are relatively ideal for preoperative localization of SPNs.…”

High-resolution computed tomography features and CT-guided microcoil localization of subcentimeter pulmonary ground-glass opacities: radiological processing prior to video-assisted thoracoscopic surgery

“…Only minor complications, i.e., a small pneumothorax and hemorrhage in the lung parenchyma, were detected on CT images. Several recent studies indicated that localization performed on the same day of surgery within a hybrid theatre is more safe and feasible (31)(32)(33).…”

Preoperative computed tomography-guided pulmonary nodule localization augmented by laser angle guide assembly

“…Preoperative computed tomography-guided pulmonary nodule localization augmented by laser angle guide assembly operative localizations that render the nodules 'visible', which many studies have attempted to oblige (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).…”