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

Abstract OBJECTIVES This case series illustrates the feasibility of single-stage image-guided video-assisted thoracoscopic surgery for simultaneous localization and removal of small solitary pulmonary nodules (SPNs). The procedure was performed in a hybrid operating room using C-arm cone-beam comput...

Full description

Saved in:
Bibliographic Details
Published in:European journal of cardio-thoracic surgery 2018-02, Vol.53 (2), p.353-358
Main Authors: Hsieh, Ming-Ju, Fang, Hsin-Yueh, Lin, Chien-Cheng, Wen, Chih-Tsung, Chen, Huan-Wu, Chao, Yin-Kai
Format: Article
Language:English
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract OBJECTIVES This case series illustrates the feasibility of single-stage image-guided video-assisted thoracoscopic surgery for simultaneous localization and removal of small solitary pulmonary nodules (SPNs). The procedure was performed in a hybrid operating room using C-arm cone-beam computed tomography equipped with a laser-guided navigation system. METHODS Between October 2016 and January 2017, 12 consecutive patients presenting with SPNs underwent image-guided video-assisted thoracoscopic surgery. The feasibility and safety of the procedure were assessed through a retrospective review of the patients’ clinical charts. RESULTS The median size of SPNs was 5.5 mm [interquartile range (IQR) 4−6 mm], whereas their median distance from the pleural surface was 11.7 mm (IQR 6−11.3 mm). All of the lesions were visible on intraoperative C-arm cone-beam computed tomography images, and localization was successful in 10 patients; thereafter, complete thoracoscopic resection was successfully performed. The median time required for the localization of SPNs was 45.5 min (IQR 36−60 min), whereas the median radiation exposure (expressed through the skin absorbed dose) was 223.2 mGy (IQR 180.3−321.3 mGy). Lesion localization was unsuccessful in 2 cases because to the development of pneumothorax induced by needle puncture. In such cases, a utility thoracotomy was required for the identification of SPNs. There was no operative mortality, and the median length of postoperative stay was 4 days (IQR 3.8–4 days). CONCLUSIONS 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.
ISSN:1010-7940
1873-734X
DOI:10.1093/ejcts/ezx309