Transbronchial microwave ablation of lung nodules with electromagnetic navigation bronchoscopy guidance—a novel technique and initial experience with 30 cases

Abstract

Background: Microwave ablation of lung nodules may provide a faster, larger and more predictable ablation zone than other energy sources, while bronchoscopic transbronchial ablation has theoretical advantage of fewer pleural-based complications than percutaneous approach. Our study aims to determine whether the novel combination of bronchoscopic approach and microwave ablation in management of lung nodules is technically feasible, safe and effective.Methods: This is a retrospective analysis of a single center experience in electromagnetic navigation bronchoscopy microwave ablation in hybrid operating room. Patients had high surgical risks while lung nodules were either proven malignant or radiologically suspicious. Primary endpoints include technical feasibility and safety.Results: Total of 30 lung nodules from 25 patients were treated. Mean nodule size was 15.1 mm, and bronchus directly leads to the nodules (bronchus sign positive) in only half of them. Technical success rate was 100%, although some nodules required double ablation for adequate coverage. Mean minimal ablation margin was 5.51 mm. The mean actual ablation zone volume was −21.4% compared to predicted, likely due to significant tissue contraction ranging from 0-43%. There was no significant heat sink effect.Mean hospital stay was 1.73 days, and only 1 patient stayed for more than 3 days. Complications included pain (13.3%), pneumothorax requiring drainage (6.67%), post-ablation reaction (6.67%), pleural effusion (3.33%) and hemoptysis (3.33%). After median follow up of 12 months, none of the nodules had evidence of progression.Conclusions: Bronchoscopic transbronchial microwave ablation is safe and feasible for treatment of malignant lung nodules. Prospective study on clinical application of this novel technique is warranted.

Robotic Assisted-Bronchoscopy With Cone-Beam CT ICG Dye Marking for Lung Nodule Localization: Experience Beyond USA

“…Our institute has been performing ENB-related procedures including biopsy ( 15 – 17 ), dye marking ( 2 – 4 ) and microwave ablation ( 18 ) using Artis Zeego with PURE® CBCT platform (Siemens Healthineers, Germany) since 2015. We launched the robotic bronchoscopy program since December 2021 and became the first centre outside of the United States to use the Monarch™ robotic platform, in the hope of deriving the benefits of improved accuracy and ergonomics during the procedure.…”

ERS International Congress 2021: highlights from the Clinical Techniques, Imaging and Endoscopy Assembly

“…Bronchoscopy-guided ablation is a novel therapeutic approach for malignant PPNs. Few pilot and model studies of radiofrequency ablation and microwave ablation (MWA) in porcine and canine models are published [ 1 , 2 ] and a few first trials have described encouraging results of bronchoscopic ablation techniques in human beings [ 3 ]. At the ERS congress 2021, L au et al .…”

Thoracic surgery in France

“…However, they encompass some morbidity that can be reduced by transbronchial access. This is why, guided endobronchial techniques are emerging for biopsy, nodule localization before VATS resection but also as therapeutic ablative procedures in non-surgical patients ( 14 ). In the future, we could expect that MWA guided by ENB may be a potential solution instead of or in combination with conventional surgery for patients with multiple pulmonary nodules ( 15 ).…”