Usefulness of Intraoperative Computer Tomography-Assisted Thoracoscopic Segmentectomy for Small-Sized Lung Cancer

Chang, Sung Soo; Nakano, Takayuki; Okamoto, Taku

doi:10.5761/atcs.cr.15-00212

Cited by 4 publications

(2 citation statements)

References 8 publications

(7 reference statements)

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“…Video-assisted thoracic surgery (VATS) is often the method of choice to resect small pulmonary lesions (15). However, intraoperative localization of small lesions can be challenging, as these are often nonvisible and nonpalpable (16)(17)(18). Modern mammography identifies lesions at increasingly smaller sizes, which are challenging for surgeons to accurately locate and excise.…”

Section: Introductionmentioning

confidence: 99%

Multimodal soft tissue markers for bridging high-resolution diagnostic imaging with therapeutic intervention

et al. 2020

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Diagnostic imaging often outperforms the surgeon’s ability to identify small structures during therapeutic procedures. Smart soft tissue markers that translate the sensitivity of diagnostic imaging into optimal therapeutic intervention are therefore highly warranted. This paper presents a unique adaptable liquid soft tissue marker system based on functionalized carbohydrates (Carbo-gel). The liquid state of these markers allows for high-precision placement under image guidance using thin needles. Based on step-by-step modifications, the image features and mechanical properties of markers can be optimized to bridge diagnostic imaging and specific therapeutic interventions. The performance of Carbo-gel is demonstrated for markers that (i) have radiographic, magnetic resonance, and ultrasound visibility; (ii) are palpable and visible; and (iii) are localizable by near-infrared fluorescence and radio guidance. The study demonstrates encouraging proof of concept for the liquid marker system as a well-tolerated multimodal imaging marker that can improve image-guided radiotherapy and surgical interventions, including robotic surgery.

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Section: Introductionmentioning

confidence: 99%

Multimodal soft tissue markers for bridging high-resolution diagnostic imaging with therapeutic intervention

et al. 2020

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“…A safe and practical tracking technique to acquire realtime information on tumor position is electromagnetic (EM) tracking of EM sensors that are implanted in or around the tumor [9]. This technique does not require a radiation dose or line-of-sight, as opposed to alternatives such as intraoperative computational tomography (CT) and the use of optical markers [10][11][12]. EM tracking has been studied in a variety of fields, including surgery [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Accuracy assessment of target tracking using two 5-degrees-of-freedom wireless transponders

et al. 2019

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Purpose Surgical navigation systems are generally only applied for targets in rigid areas. For non-rigid areas, real-time tumor tracking can be included to compensate for anatomical changes. The only clinically cleared system using a wireless electromagnetic tracking technique is the Calypso ® System (Varian Medical Systems Inc., USA), designed for radiotherapy. It is limited to tracking maximally three wireless 5-degrees-of-freedom (DOF) transponders, all used for tumor tracking. For surgical navigation, a surgical tool has to be tracked as well. In this study, we evaluated whether accurate 6DOF tumor tracking is possible using only two 5DOF transponders, leaving one transponder to track a tool. Methods Two methods were defined to derive 6DOF information out of two 5DOF transponders. The first method uses the vector information of both transponders (TTV), and the second method combines the vector information of one transponder with the distance vector between the transponders (OTV). The accuracy of tracking a rotating object was assessed for each method mimicking clinically relevant and worst-case configurations. Accuracy was compared to using all three transponders to derive 6DOF (Default method). An optical tracking system was used as a reference for accuracy. Results The TTV method performed best and was as accurate as the Default method for almost all transponder configurations (median errors < 0.5°, 95% confidence interval < 3°). Only when the angle between the transponders was less than 2°, the TTV method was inaccurate and the OTV method may be preferred. The accuracy of both methods was independent of the angle of rotation, and only the OTV method was sensitive to the plane of rotation. Conclusion These results indicate that accurate 6DOF tumor tracking is possible using only two 5DOF transponders. This encourages further development of a wireless EM surgical navigation approach using a readily available clinical system.

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Small lung lesions invisible under fluoroscopy are located accurately by three-dimensional localization technique on chest wall surface and performed bronchoscopy procedures to increase diagnostic yields

Deng

Cao²,

et al. 2016

BMC Pulm Med

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BackgroundNowadays, small peripheral pulmonary lesions (PPLs) are frequently detected and the prognosis of lung cancer depends on the early diagnosis. Because of the high fee and requiring specialized training, many advanced techniques are not available in many developing countries and rural districts.MethodsThree sets of opaque soft copper wires visible under the fluoroscopy (Flu) in the Flu-flexible bronchoscopy (FB) group (n = 24), which determined the three planes of the lesion, were respectively placed firmly on the surface of the chest wall with adhesive tape on the chest wall. The FB tip was advanced into the bronchus toward the crosspoint of the three perpendicular planes under Flu with careful rotation of a C-arm unit. Then the specimen were harvested focusing around the crosspoint for pathologic diagnosis. The rapid on-site evaluation (ROSE) procedure was also performed. The average Flu time during FB procedures were recorded and diagnostic accuracy rates in the Flu-FB group were compared with the other group guided by radial endobronchial ultrasound (R-EBUS) (n = 23).ResultsThe location of the core point of the lesion, whether it was visible or not under the fluoroscopy could be recognized by three-dimensional localization technique. The accuracy rates of diagnostic yields were 62.5% in the Flu-FB group, and was similar as 65.2% in the R-EBUS group (P > 0.05). However, in the Flu-FB group, there was a decreasing tendency on accurate diagnosis rates of lower lobe (LL) lesions when comparing with non-LL lesions (3/8 = 37.5% vs 12/16 = 75%, P = 0.091) while in the R-EBUS group it was similar (9/12 = 75% vs 6/11 = 54.6%, P = 0.278). In the Flu-FB group, fluoroscopy time was negatively correlated with the lesion length (r = −0.613, P = 0.001), however, there was no significant difference between the lesions invisible or not (5.83 ± 1.45 min vs 7.67 ± 2.02 min, P = 0.116) under the fluoroscopy, as well as no significant difference among SPN, mGGO and GGO (6.12 ± 2.05 min, 7.25 ± 1.33 min and 7.80 ± 2.02 min, P > 0.05).ConclusionsSmall PPL whether it is visible or not under fluoroscopy can be located accurately by our three-dimensional localization technique on chest wall surface and performed bronchoscopy procedures to increase diagnostic yields. It is more convenient, economical and reliable with the similar diagnostic yields than R-EBUS guided method.Trial registrationCurrent Controlled Trials ChiCTR-DDD-16009715. The date of registration: 3rd Nov, 2016. Retrospectively registered.

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Usefulness of Intraoperative Computer Tomography-Assisted Thoracoscopic Segmentectomy for Small-Sized Lung Cancer

Cited by 4 publications

References 8 publications

Multimodal soft tissue markers for bridging high-resolution diagnostic imaging with therapeutic intervention

Multimodal soft tissue markers for bridging high-resolution diagnostic imaging with therapeutic intervention

Accuracy assessment of target tracking using two 5-degrees-of-freedom wireless transponders

Small lung lesions invisible under fluoroscopy are located accurately by three-dimensional localization technique on chest wall surface and performed bronchoscopy procedures to increase diagnostic yields

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