Tailored intraoperative localization of non‐palpable pulmonary lesions for thoracoscopic wedge resection using hybrid room technology

Stanzi, Alessia; Mazza, Federico; Lucio, Francesco; Ghirardo, Donatella; Grosso, Maurizio; Locatelli, Alessandro; Melloni, Giulio

doi:10.1111/crj.12725

Cited by 11 publications

(8 citation statements)

References 16 publications

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“…Stanzi et al reported encouraging results in terms of successful localization using both hookwires and coils, effectiveness of VATS procedures (only 1 conversion to thoracotomy out of 11 iVATS), overall procedural time, complication rates (no pneumothorax, no wire dislodgement) and radiation exposure using HOR and iVATS for non-palpable lung nodules (31).…”

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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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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“…Lipiodol has been reported to have favorable factors include less diffusion and long presentation (even greater than three months) but there is a risk of causing allergies and embolism if this contrast agent accidentally reached the systemic circulation. 14 In addition, the CT-G localization methods have common deficiencies, [15][16][17] such as physical discomfort, psychological stress, ionizing radiation exposure, occupying radiology resources and increasing the burden of logistics department. Virtual-assisted lung mapping (VAL-MAP) is a preoperative bronchoscopic multispot dye-marking technique using virtual images.…”

Section: Discussionmentioning

confidence: 99%

Three‐dimensional printed navigational template for localizing small pulmonary nodules: A case‐controlled study

Chai

Zhang

et al. 2020

Thoracic Cancer

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Background Localization of small pulmonary nodules is an inevitable challenge for the thoracic surgeon. This study aimed to investigate the accuracy of three‐dimensional (3D) printing technology for localizing small pulmonary nodules, especially ground‐glass nodules (GGNs). Methods This study enrolled patients with peripheral small pulmonary nodules (≤ 2 cm) who required preoperative localization. In the comparison period, patients underwent both computed tomography‐guided (CT‐G) and 3D‐printing template guided (3D‐G) localization to compare the accuracies of the two methods. In the testing period, the 3D‐printing technique was implemented alone. The 3D‐printing physical navigational template was designed based on data from perioperative CT images. Clinical data, imaging data, surgical data, and evaluation index were collected for further analysis. The learning curve of the 3D‐printing localization technique was assessed using cumulative sum (CUSUM) analysis and multiple linear regression analysis. Results In the comparison period (n = 14), the success rates of CT‐G and 3D‐G were 100% and 92.9% (P = 0.31), respectively; in the testing period (n = 23), the success rate of 3D‐G was 95.6%. The localization times of CT‐G, 3D‐G (comparison), and 3D‐G (testing) were 23.6 ± 5.3, 19.3 ± 6.8, and 9.8 ± 4.6 minutes, respectively. The CUSUM learning curve was modeled using the equation: Y = 0.48X2 − 0.013X − 0.454 (R2 = 0.89). The learning curve was composed of two phases, phase 1 (the initial 20 patients) and phase 2 (the remaining 17 patients). Conclusions 3D printing localization has adequate accuracy and is a feasible and accessible strategy for use in localizing small pulmonary nodules, especially in right upper lobe. The use of this technique could facilitate lung nodule localization prior to surgery.

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“…We previously reported detailed patient positioning and CBCT acquisition protocols. 16 CBCT images were jointly reviewed by radiologistsandsurgeonstoconfirmthepresenceofthetargetlesion and to plan the needle trajectory for the percutaneous placement of the metallic marker. The trajectory (Fig.…”

Section: Ivats Procedural Workflowmentioning

confidence: 99%

“…An extended delay in surgery after localization may result in an increased risk of complications, such as pneumothorax or marker dislodgement. 15 Wepreviouslyreportedourworkflowforsingle-stageintraoperative localization and thoracoscopic removal of nonpalpable pulmonary nodules in HOR, 16 based on the alternative use of 2 different types of metallic markers, depending on target characteristics. The aim of the present study is to evaluate the localization yield of iVATS wedge resection in a larger cohort of consecutive patients with nonpalpable pulmonary nodules.…”

Section: Introductionmentioning

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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Tailored intraoperative localization of non‐palpable pulmonary lesions for thoracoscopic wedge resection using hybrid room technology

Abstract: Our experience confirms that HOR is suitable for simultaneous localization and VATS resection of 'difficult' pulmonary lesions. A versatile approach, using different devices, seems advisable for the removal of targets in every clinical scenario, reducing the VATS conversion rate.

Cited by 11 publications

References 16 publications

Preoperative localization of solitary pulmonary nodule: a narrative review

Preoperative localization of solitary pulmonary nodule: a narrative review

Three‐dimensional printed navigational template for localizing small pulmonary nodules: A case‐controlled study

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

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