Image-guided Preoperative Localization of Pulmonary Nodules for                     Video-assisted and Robotically Assisted Surgery

McDermott, Shaunagh; Fintelmann, Florian J.; Bierhals, Andrew J.; Silin, Douglas; Price, Max; Ott, Harald C.; Shepard, Jo-Anne O.; Mayo, John R.; Sharma, Amita

doi:10.1148/rg.2019180183

Cited by 42 publications

(30 citation statements)

References 49 publications

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“…Accurate localization of small nodules using VATS has been reported to be challenging, especially for multiple, deep-seated or ground-glass nodules (10,11). The methylene blue dye localization of pulmonary nodules was first reported in 1994 (12), with high success rate and short procedure time via both transthoracic and endobronchial route under CT or fluoroscopic guidance (13,14). Although preoperative dye localization for lung nodules has been previously studied (10,11,13,(15)(16)(17)(18)(19), there was limited research focusing on the efficacy and feasibility (20).…”

Section: Introductionmentioning

confidence: 99%

Computed Tomography-Guided Methylene Blue Localization: Single vs. Multiple Lung Nodules

et al. 2021

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Background: Preoperative localization for small invisible and impalpable pulmonary nodules is important in single-port video-assisted thoracoscopic surgery (VATS). Localization of multiple pulmonary nodules during VATS resection remains challenging. The aim of our study is to elucidate the efficacy of preoperative CT-guided methylene blue localization of both single and multiple pulmonary nodules.Methods: Consecutive patients undergoing preoperative CT-guided methylene blue dye localization for lung nodules, followed by VATS resection, were retrospectively analyzed between January 2014 and November 2019. Chi-square tests, Fisher's exact test and independent T-test were used to compare variables between the groups. Logistic regression was used to identify risk factors for procedure-related complications.Results: A total of 388 patients, including 337 with single nodule and 51 with multiple nodules, were analyzed. The success rate of preoperative CT-guided methylene blue localization for both single and multiple pulmonary nodules were comparable as 98.8% (333/337) vs. 100% (108/108). The procedure time was longer (23.2 ± 9.4 vs. 7.6 ± 4.8 min, p < 0.001) and risk of pneumothorax was higher (47.1 vs. 25.5%, p = 0.002) in the multiple nodule group. The procedure time (OR 1.079; 95% CI = 1.041–1.118; p < 0.001) was an independent risk factor for pneumothorax. Nodule depth (OR 2.829; 95% CI = 1.259–6.356; p = 0.011) was an independent risk factor for pulmonary hemorrhage.Conclusions: Preoperative CT-guided methylene blue localization for both single and multiple pulmonary nodules is safe, feasible, and effective.

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Section: Introductionmentioning

confidence: 99%

Computed Tomography-Guided Methylene Blue Localization: Single vs. Multiple Lung Nodules

et al. 2021

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“…Another concern about CT-guided techniques is the radiation exposure during the localization procedure and the intraoperative identification of radio-opaque markers, both for patients and involved personnel: the radiation doses should be considered in the choice of the proper localization procedure. Considering hookwire technique, one of the main limits leading to failure of marking is wire dislodgement due to patients' movements between the localization procedure and the surgical resection, (ranging from 4.5% to 9% of cases) even if the hookwire is well anchored to the skin with Band-Aids (24). However, in some cases, the lesion can still be identified following the pleural hematoma on the surface of the lung.…”

Section: Discussionmentioning

confidence: 99%

Preoperative localization of solitary pulmonary nodule: a narrative review

Diotti¹,

Musso²,

Mazzucco³

et al. 2021

AME Surg J

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The diffusion of lung cancer screening programs using CT scan and the improvement in imaging technologies have led to an increased number of indeterminate solid and subsolid small lung lesions, in which percutaneous or bronchoscopic diagnostic procedures may be unsuccessful or not technically feasible. In these cases, a surgical resection using minimally invasive techniques can be indicated, with both diagnostic and therapeutic purposes. Intraoperative detection of small lung nodules is still a challenge for surgeons, especially in the era of video and robot-assisted thoracic surgery, which could make direct finger palpation of lung parenchyma through thoracoscopic incisions demanding and thus require conversion to a standard thoracotomy to find the lesion. In this scenario, several preoperative and intraoperative localization techniques for small lung nodules are available, from image-guided techniques with percutaneous markers placement or injection of liquid agents (dyes, radio-tracers), to novel promising marking methods using electromagnetic navigation bronchoscopy (ENB) or Hybrid Room technology. The proper localization technique should be selected according to the lesion's position, size, and radiological characteristics, as well as the expertise and the preferences of the staff performing preoperative and surgical procedures. The aim of this narrative review is to describe and compare various available preoperative and intraoperative localization techniques in terms of safety, possible complications, cost/effectiveness and feasibility in everyday clinical practice, and to provide information on this topic for clinicians dealing with non-palpable or deep-located small lung nodules.

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“…Intraoperative identification and resection of suspected malignant pulmonary nodules, especially non-visible and non-palpable ground-glass opacities, is a challenging issue during VATS (5). Precise preoperative localization is the key to improving the success rate and safety of thoracoscopic sub-lobectomy resection.…”

Section: Discussionmentioning

confidence: 99%

“…The increasing popularity of low dose chest computed tomography (CT) scan has resulted in a corresponding increased detection of pulmonary nodules (1-3) and video-assisted thoracoscopic surgery (VATS) has become a safe and minimally invasive method for the diagnosis and treatment of small pulmonary nodules (4). However, the localization of lesions during VATS can be difficult, especially for non-visible and non-palpable ground-glass opacities (5). The accurate preoperative localization of small pulmonary nodules facilitates the rapid and precise intraoperative resection of target lesions, which is of great significance for VATS.…”

Section: Introductionmentioning

confidence: 99%

The feasibility of navigation bronchoscopy-guided pulmonary microcoil localization of small pulmonary nodules prior to thoracoscopic surgery

Chen

Pan

et al. 2020

Transl Lung Cancer Res

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Background: Accurate preoperative localization of small pulmonary nodules facilitates the rapid and precise video-assisted thoracoscopic surgery (VATS). This study aims to evaluate the feasibility, safety, and efficacy of navigation bronchoscopy-guided pulmonary microcoil placement for preoperative pulmonary nodule localization.Methods: Twelve lung lesions were simulated by mixing lipiodol in three porcine models. After 1 week, two microcoils per lesion were deployed under bronchoscopic guidance. Computed tomography scans were then performed 1 day, 1 week, 2 weeks, and 4 weeks after the deployment to assess the position of the microcoils relative to the lesions. Surgical resection of the simulated lesions was performed under fluoroscopy 5 weeks after the deployment and the accuracy, stability, and associated complications of the microcoil localization were evaluated. Following this, an exploratory clinical study was conducted on three patients with pure ground-glass pulmonary nodules. Results:The mean diameter of the twelve simulated lung lesions was 9.55±2.36 mm, and the mean distance from the pleura to the lesions was 8.29±2.99 mm. Twenty-four pulmonary microcoils were implanted in the bronchi surrounding the lesions. Four weeks later, the mean distance between the microcoils and the center of the lesions was 16.12±8.97 mm and the average migration of the microcoils relative to the baseline position (1 day after implantation) was 3.48±4.56 mm. All microcoils and target lesions were successfully resected in both the animal experiment and clinical study and no complications, such as pneumothorax, were observed during marker implantation or postoperative follow-up. Conclusions:The preoperative localization of pulmonary nodules by navigation bronchoscopy-guided microcoil placement is a safe, stable, and effective technique with minimal complication risk. This procedure can assist subsequent thoracoscopic resection.

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Image-guided Preoperative Localization of Pulmonary Nodules for Video-assisted and Robotically Assisted Surgery

Cited by 42 publications

References 49 publications

Computed Tomography-Guided Methylene Blue Localization: Single vs. Multiple Lung Nodules

Computed Tomography-Guided Methylene Blue Localization: Single vs. Multiple Lung Nodules

Preoperative localization of solitary pulmonary nodule: a narrative review

The feasibility of navigation bronchoscopy-guided pulmonary microcoil localization of small pulmonary nodules prior to thoracoscopic surgery

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