Single-stage augmented fluoroscopic bronchoscopy localization and thoracoscopic resection of small pulmonary nodules in a hybrid operating room

Abstract

Objectives Hybrid operating rooms have been increasingly used for image-guided lung surgery, and most surgical teams have used percutaneous localisation for small pulmonary nodules. We evaluated the feasibility and safety of augmented fluoroscopic bronchoscopy localisation under endotracheal tube intubation general anaesthesia followed by thoracoscopic surgery as a single-stage procedure in a hybrid operating room. Methods We retrospectively reviewed clinical records of patients who underwent single-stage augmented fluoroscopic bronchoscopy localisation under general anaesthesia followed by thoracoscopic surgery in a hybrid operating room between August 2020 and March 2022. Results Single-stage localisation and resection were performed for 85 nodules in 74 patients. Median nodule size was 8 mm (interquartile range [IQR], 6–9 mm), and median distance from the pleural space was 10.9 mm (IQR, 8–20 mm). All nodules were identifiable on cone-beam computed tomography images and marked transbronchially with indigo carmine dye (median markers per lesion: 3); microcoils were placed for deep margins in 16 patients. Median localisation time was 30 min (IQR 23–42 min), and median fluoroscopy duration was 3.3 min (IQR 2.2–5.3 min). Median radiation exposure (expressed as the dose area product) was 4303.6 μGym2 (IQR 2879.5-6268.7 μGym2). All nodules were successfully marked and resected, and the median global operating room time was 178.5 min (IQR 153.5–204 min). There were no localisation-related complications, and median length of postoperative stay was 1 d (IQR, 1–2 d). Conclusions Single-stage augmented fluoroscopic bronchoscopy localisation under general anaesthesia followed by thoracoscopic surgery was feasible and safe.

2024 multidisciplinary consensus on image‐guided lung tumor ablation from the Taiwan Academy of Tumor Ablation

“…Invasive thoracic procedures involving ablation can be performed under general anesthesia within the controlled environment of a hybrid operating room. [37][38][39] Individual differences during imaging, such as performing the procedure under real-time fluoroscopy or a CT scanner, single-lung ventilation (or lung separation), and general anesthesia, may vary across hospitals based on individual expertise and resource availability. These details are typically not included in standardized guidelines because of the need for flexibility and adaptation under specific circumstances.…”

“…A hybrid operating room equipped with conventional MDCT and/or CBCT allows for accurate navigation and device positioning during the procedure. Invasive thoracic procedures involving ablation can be performed under general anesthesia within the controlled environment of a hybrid operating room 37–39 …”

“…Invasive thoracic procedures involving ablation can be performed under general anesthesia within the controlled environment of a hybrid operating room. 37 , 38 , 39 …”