Electromagnetic navigation bronchoscopic dye marking for localization of small subsolid nodules

Hyun, Kyung; Park, In Kyu; Song, Jung Han; Park, Samina; Kang, Chang Hyun; Kim, Young Tae

doi:10.1097/md.0000000000014831

Cited by 12 publications

(10 citation statements)

References 28 publications

(44 reference statements)

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“…It is recommended for patients with emphysematous lung disease or COPD since it is associated with less complications such as pneumothorax and bronchial hemorrhage 16,17 . It also has the advantage of improved patient comfort as it is carried out under general anesthesia, and is a seamless procedure between localization and surgery without moving settings, therefore minimizing procedure time and risk 18,19 . The bronchoscopic approach facilitates entry into the regions that are not easily accessible by the percutaneous approach, such as nodules located near the costophrenic angle or under the scapula (such as the mediastinal side and the craniodorsal part obscured by the scapula) 7,8 .…”

Section: Discussionmentioning

confidence: 99%

Electromagnetic navigation bronchoscopic localization versus percutaneous CT‐guided localization for thoracoscopic resection of small pulmonary nodules

Yang

Huang

et al. 2021

Thoracic Cancer

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Background Identification of small pulmonary nodules is challenging in a limited intrathoracic field during minimally invasive video‐assisted thoracoscopic surgery (VATS), and preoperative localization is required. Various techniques have been reported with some failure and complications. Here, we compare the feasibility and safety between electromagnetic navigation bronchoscopic marking and computed tomography (CT)‐guided percutaneous marking using indocyanine green (ICG) and iopamidol. Methods A total of 47 patients with small‐sized pulmonary nodules, scheduled to undergo video‐assisted thoracoscopic limited resection, were enrolled in this study. A mixture of diluted ICG and iopamidol was injected into the lung parenchyma as a marker, using CT‐guided percutaneous or electromagnetic navigation bronchoscopic injection techniques and the results were examined and compared. Results A total of 35 and 12 patients underwent preoperative marking by percutaneous injection and electromagnetic navigation bronchoscopic injection, respectively, in which a marker was detected in 33/35 (94.3%) and 12/12 (100%) patients. No combination of these procedures was performed in any patient. All markers were successfully detected in three patients who underwent injection marking at two different lesion sites. Pneumothorax occurred in five patients (14%) in the percutaneous marking group, which was relieved in all patients without the necessity for chest tube drainage. No other complication was observed in this study. Conclusions Electromagnetic navigation bronchoscopic injection techniques using indocyanine green fluorescence plus iopamidol are safe and effective, and comparable with CT‐guided localization. Furthermore, a bronchoscopic approach enables marking of multiple lesion areas without increasing patient risk, especially for puncture‐related pneumothorax. Key points Significant findings of the study Either computed tomography (CT)‐guided percutaneous or electromagnetic navigation bronchoscopic injection techniques can be used for preoperative marking of pulmonary nodules with indocyanine green (ICG) fluorescence. What this study adds Indocyanine green (ICG) is a safe and easily detectable fluorescent marker for video‐assisted thoracoscopic surgery (VATS). A bronchoscopic injection approach enables marking of multiple lesion areas without increasing the risk of pneumothorax.

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Section: Discussionmentioning

confidence: 99%

Electromagnetic navigation bronchoscopic localization versus percutaneous CT‐guided localization for thoracoscopic resection of small pulmonary nodules

Yang

Huang

et al. 2021

Thoracic Cancer

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“…More recently, ENB‐guided dye marking has been proven as a valuable method in thoracic surgery. The success rate of ENB‐guided localization for small lung lesions ranges from 97.2% to 100% 8 . In this study, we aimed to explore the feasibility of the ENB‐guided dye marking method to identify the subsegmental bronchus in subsegmentectomy.…”

Section: Discussionmentioning

confidence: 99%

“…The success rate of ENB‐guided localization for small lung lesions ranges from 97.2% to 100%. 8 In this study, we aimed to explore the feasibility of the ENB‐guided dye marking method to identify the subsegmental bronchus in subsegmentectomy. Our research has confirmed that the ENB‐guided dye marking method is feasible and effective for identification of the subsegmental bronchus.…”

Section: Discussionmentioning

confidence: 99%

Electromagnetic navigational bronchoscopy‐guided dye marking to identify the subsegmental bronchus in thoracoscopic anatomic subsegmentectomy

Min

Zhao

et al. 2021

Thoracic Cancer

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Video‐assisted thoracoscopic surgery (VATS) subsegmentectomy has been widely used to resect small‐sized lung lesions in clinical practice. Precise identification of the subsegmental bronchus is one of the essential steps in performing thoracoscopic anatomic subsegmentectomy. Here, we report a thoracoscopic right S2a segmentectomy with preoperative electromagnetic navigational bronchoscopy (ENB)‐guided injection of methylene blue to identify the subsegmental bronchus in a 51‐year‐old male. We successfully performed complicated surgery using this method. This ENB‐guided dye marking method may accurately distinguish the subsegmental bronchus to effectively guide surgery.

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“…All marked nodules were completely resected thoracoscopically. Technically, we found a pathway with an obtuse approach angle should be selected to increase the navigation accuracy [33]. If the lesion is located in an area that requires an acute angle, the localization is not feasible, and we often have to use CT guided technique.…”

Section: The Third Dilemma: How To Localize Ggn?mentioning

confidence: 99%

Management of Ground-Glass Nodules: When and How to Operate?

Kim

2022

Cancers

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With the increased popularity of low-dose computed tomography (LDCT), many patients present with pulmonary ground-glass nodules (GGNs), and the appropriate diagnostic and management strategy of those lesions make physicians be on the horn of the clinical dilemma. As there is not enough data available to set universally acceptable guidelines, the management of GGNs may be different. If GGN is an incidental finding through LDCT, the lesion should be followed according to the current guidelines. We recommend a multidisciplinary team discussion to be initiated if a new solid component develops or the solid portion size grows on follow-up CT as the risk of malignancy is high. Attempts to preoperatively biopsy solid components in part-solid GGNs are often not feasible and not helpful in clinical settings. Currently, if malignancy is suspected, a surgical biopsy with the guidance of various localization methods is recommended. If malignancy is confirmed, sub-lobar resection may provide an excellent oncologic outcome.

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Electromagnetic navigation bronchoscopic dye marking for localization of small subsolid nodules

Abstract: Supplemental Digital Content is available in the text

Cited by 12 publications

References 28 publications

Electromagnetic navigation bronchoscopic localization versus percutaneous CT‐guided localization for thoracoscopic resection of small pulmonary nodules

Electromagnetic navigation bronchoscopic localization versus percutaneous CT‐guided localization for thoracoscopic resection of small pulmonary nodules

Electromagnetic navigational bronchoscopy‐guided dye marking to identify the subsegmental bronchus in thoracoscopic anatomic subsegmentectomy

Management of Ground-Glass Nodules: When and How to Operate?

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