Single-stage localization and removal of small lung nodules through image-guided video-assisted thoracoscopic surgery

Abstract

The results of our case series support the feasibility of image-guided video-assisted thoracoscopic surgery for detection and removal of SPNs. Future efforts should be tailored to decrease localization time and minimize radiation exposure.

Single-stage hybrid localization: a combination of bronchoscopic lung mapping followed by post-mapping computed tomographic reconstruction and additional transthoracic needle localization in a cone beam computed tomography room

“…Even though syngo Needle Guidance system was applied to our practice, the number of DynaCT did not decrease during needle procedure, which could be attributed to the preference of our radiologist, who usually performs needle localization under guidance of conventional MDCT with repeated CT scans for confirming the location of the needle. In recent studies, the number of DynaCT could be limited to 2-3 for a single dye or hookwire localization by utilizing real-time fluoroscopy to guide needle passage and reaching to the target (14).…”

Image-guided video-assisted thoracoscopic surgery for small ground glass opacities: a case series

“…To circumvent this issue, we believed a better understanding of the limitation of reciprocal positioning of the patient, surgical table, and C-arm is of paramount importance. We have identified several useful maneuvers (including table height management and adjustments of the patient position) that may be helpful to reduce the procedural time (16). The implementation of these maneuvers as we overcame the initial procedure-related learning curve resulted in an increase of successful GGOs localization in the lateral decubitus position (100%) over the latter 10 patients.…”

Image‐guided video‐assisted thoracoscopic resection (iVATS): Translation to clinical practice—real‐world experience

“…There is an emerging body of research into developing and evaluating localization techniques that can help targeted resection of small lung nodules 9‐12 . These techniques are combined with surgery and include intraoperative adjuncts (ultrasound, fluoroscopy); markers placed preoperatively or intraoperatively, such as hookwires, fiducials, microcoils, or radioactive seeds; dyes (methylene blue and indocyanine green [ICG]); and molecular targets (flourophores) 13‐24 . The markers (fiducials, dyes, and tracers) may be placed in the imaging suite a few hours before surgery or within the hybrid operating room (OR) just before the surgery.…”