Hybrid operating room for the intraoperative CT-guided localization of pulmonary nodules

Fang, Hsin-Yueh; Chang, Ko‐Wei; Chao, Yin-Kai

doi:10.21037/atm.2018.12.48

Cited by 22 publications

(21 citation statements)

References 26 publications

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“…Some scholars have proposed methods that do not rely on CT guided lung puncture positioning, such as the use of intrathoracic natural anatomical markers, intraoperative ultrasound, 3D printing navigational template, intraoperative virtual reality, magnetic navigation/virtual bronchoscope (5)(6)(7)(8)(9)(10)(11)(12). These methods reduce the risk of puncture, but the economic and time cost for latter several methods are too expensive to implement.…”

Section: Discussionmentioning

confidence: 99%

Post-Anesthesia Hookwire Localization of Pulmonary Ground Glass Nodules Guided by Computed-Tomography Three-Dimensional Reconstruction: A Feasibility Study

Wang

Liu

Xiao

et al. 2021

Preprint

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Background: Computed-tomography(CT) guided hookwire localization has disadvantages, such as pain, patient transport risk and increased radiation exposure. In order to overcome the above shortcomings, our method is post-anesthesia hookwire localization guided by preoperative CT three-dimensional reconstruction. The effectiveness and safety of this method will be studied.Methods: A total of 36 patients(36 nodules) with ground glass nodules were consecutively included in this study. Three dimensional reconstruction of chest CT was performed to simulate the puncture path. The puncture point, the depth and angle of needle insertion were recorded. After anesthesia, the puncture point was marked on the patient's body surface. Hookwire was placed according to the previous planned puncture direction and depth. The effectiveness and complications of the localization were evaluated during the operation.Results: Hookwire dislocation was found in 1 patient in operation. The other 35 nodules were successfully positioned. The median distance between hookwire and lesion was 14mm(3-25mm). The effective rate was 97.2%(35/36). Only one patient found a small amount of blood in the chest. There was no pulmonary hematoma, blood pressure or oxygen decreasing in all patients. The complication rate was 2.8% (1/36) and the severe complication was 0. The median time for localization was 3 minutes. Conclusion: Post-anesthesia hookwire localization guided by preoperative three-dimensional reconstruction is a simple, safe and effective localization method, which is suitable for appropriate nodules, and is an important supplement to CT guided localization.Trial registration: ChiCTR1900023853. Registered in Chinese Clinical Trail Registry on 14 June 2019, http://www.chictr.org.cn/showprojen.aspx?proj=40060

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Section: Discussionmentioning

confidence: 99%

Post-Anesthesia Hookwire Localization of Pulmonary Ground Glass Nodules Guided by Computed-Tomography Three-Dimensional Reconstruction: A Feasibility Study

Wang

Liu

Xiao

et al. 2021

Preprint

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“…For most of them, the use in a HOR is already reported, but currently, no clear recommendation can be made on the optimal methodology. 25 In our experience, we used2differenttypesofmetallicmarkersdependingonthetarget position. Due to the need for intraoperative fluoroscopy, cases managed with coil showed a longer surgical time as compared with those managed with hookwire.…”

Section: Discussionmentioning

confidence: 99%

Single-Stage Localization and Thoracoscopic Removal of Nonpalpable Pulmonary Nodules in a Hybrid Operating Room

Mazza

Venturino

Peano

et al. 2020

Innovations�(Phila)

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Objective We report our experience with simultaneous localization and thoracoscopic removal for nonpalpable undiagnosed pulmonary nodules. Methods All patients with nonpalpable lesions requiring video-assisted thoracoscopic surgery (VATS) wedge resection underwent localization of the targets and surgical removal in a hybrid operating room. Lesions were considered nonpalpable if they were small (<1 cm), deep (>1 cm from the surface), subsolid, or located within a dystrophic area. In all cases, intraoperative cone-beam computed tomography was performed for nodule localization and targeting, metal hookwires, or coils were alternatively used for intraoperative marking. Results From April 2016 to November 2019, 39 image-guided VATS (iVATS) were performed. The mean lesion size was 12 ± 6 mm. The mean distance from the deep edge of the lesion to the pleural surface was 24 ± 9 mm. The localization was performed with 20 hookwires and 19 coils. iVATS localization was successful in 36 patients (92.3%). Thirty-seven wedge resections were completed by VATS, 2 (5%) required conversion to thoracotomy. In 9 patients with intraoperative diagnosis of lung cancer, a lobectomy was performed (7 VATS and 2 thoracotomies). Mean length of iVATS localization was 30 ± 13 minutes. Median postoperative length of stay was 4 days (IQR 3 to 5). Conclusions iVATS seems to be a helpful tool for simultaneous localization and removal of nonpalpable nodules. A versatile approach using different devices seems advisable for the removal of targets in every clinical scenario reducing VATS conversion rate. Future research is required to compare iVATS with traditional preoperative localization techniques.

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“…The incidence of complications such as pneumothorax, wire dislodgement or dye diffusion correlates with time elapsed between nodule marking and surgery. Thus, intraoperative CT-guided (IOCT) VATS may reduce these complications by minimizing the time interval from localization to excision of non-palpable lung lesions, a step forward compared to the usual methodology that involves patient transportation from the CT suite to the operating room (52).…”

Section: Hybrid Operating Roommentioning

confidence: 99%

Perioperative identifications of non-palpable pulmonary nodules: a narrative review

et al. 2021

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Early detection of lung cancer is the key to improving treatment and prognosis of this disease, and the advent of advances in computed tomography (CT) imaging and national screening programs have improved the detection rate of very small pulmonary lesions. As such, the management of this subcentimetric and often sub-solid lesions has become quite challenging for clinicians, especially for choosing the most suitable diagnostic method. In clinical practice, to fulfill this diagnostic yield, transthoracic needle biopsy (TTNB) is often the first choice especially for peripheral nodules. For lesions for which TTNB could present technical difficulties or failed, other diagnostic strategies are needed. In this case, videoassisted thoracic surgery (VATS) is the gold standard to reach the diagnosis of lung nodules suspect of being malignant. Nonetheless it's often not easy the identification of such lesions during VATS because of their little dimensions, non-firm consistency, deep localization. In literature various marking techniques have been described, in order to improve intraoperative nodules detection and to reduce conversion rate to thoracotomy: CT-guided hookwire positioning, methylene blue staining, intra-operative ultrasound and electromagnetic navigation bronchoscopy are the most used. The scientific evidence on this matter is weak because there are no randomized clinical trials but only case series on single techniques with no comparison on efficacy, so there are no guidelines to refer. From this standing, in this article we conducted a narrative review of the existing literature on the subject, with the aim of outlining a framework as complete as possible.We analyzed strengths and weaknesses of the main techniques reported, so as to allow the clinician to orient himself with greater ease.

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Hybrid operating room for the intraoperative CT-guided localization of pulmonary nodules

Cited by 22 publications

References 26 publications

Post-Anesthesia Hookwire Localization of Pulmonary Ground Glass Nodules Guided by Computed-Tomography Three-Dimensional Reconstruction: A Feasibility Study

Post-Anesthesia Hookwire Localization of Pulmonary Ground Glass Nodules Guided by Computed-Tomography Three-Dimensional Reconstruction: A Feasibility Study

Single-Stage Localization and Thoracoscopic Removal of Nonpalpable Pulmonary Nodules in a Hybrid Operating Room

Perioperative identifications of non-palpable pulmonary nodules: a narrative review

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