Preoperative versus intraoperative image-guided localization of multiple ipsilateral lung nodules

Abstract OBJECTIVES Computed tomography (CT)-guided localization of multiple ipsilateral pulmonary nodules remains challenging. Hybrid operating rooms equipped with cone-beam CT and laser navigation systems have the potential for improving clinical workflows and patient outcomes. METHODS Patients with multiple ipsilateral pulmonary nodules requiring localization were divided according to the localization method [preoperative CT-guided (POCT group) localization versus intraoperative CT-guided (IOCT group) localization]. The 2 groups were compared in terms of procedural efficacy, safety and radiation exposure. RESULTS Patients in the IOCT (n = 12) and POCT (n = 42) groups did not differ in terms of demographic and tumour characteristics. Moreover, the success and complication rates were similar. Notably, the IOCT approach allowed multiple nodules to be almost simultaneously localized—resulting in a shorter procedural time [mean difference (MD) −15.83 min, 95% confidence interval (CI) −7.97 to −23.69 min] and lower radiation exposure (MD −15.59 mSv, 95% CI −7.76 to −23.42 mSv) compared with the POCT approach. However, the total time under general anaesthesia was significantly longer in the IOCT group (MD 34.96 min, 95% CI 1.48–68.42 min), despite a similar operating time. The excess time under anaesthesia in the IOCT group can be attributed not only to the procedure per se but also to a longer surgical preparation time (MD 21.63 min, 95% CI 10.07–33.19 min). CONCLUSIONS Compared with the POCT approach, IOCT-guided localization performed in a hybrid operating room is associated with a shorter procedural time and less radiation exposure, albeit at the expense of an increased time under general anaesthesia.

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Video-Assisted Thoracoscopic Surgery after Preoperative CT-Guided Lipiodol Marking of Small or Impalpable Pulmonary Nodules

Annals of Thoracic and Cardiovascular Surgery ◽

10.5761/atcs.oa.15-00018 ◽

2015 ◽

Vol 21 (5) ◽

pp. 435-439 ◽

Cited By ~ 10

Author(s):

Akira Mogi ◽

Toshiki Yajima ◽

Kenji Tomizawa ◽

Ryoichi Onozato ◽

Shigebumi Tanaka ◽

...

Keyword(s):

Thoracoscopic Surgery ◽

Pulmonary Nodules ◽

Ct Guided ◽

Video Assisted ◽

Preoperative Ct ◽

Lipiodol Marking ◽

Video Assisted Thoracoscopic Surgery

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CT fluoroscopy guidance versus conventional CT guidance for percutaneous pulmonary nodule biopsy- a comparison of patient radiation exposure, procedural time, and complication rates

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2013.12.545 ◽

2014 ◽

Vol 25 (3) ◽

pp. S202-S203 ◽

Cited By ~ 1

Author(s):

S. Black ◽

A. Peterson

Keyword(s):

Radiation Exposure ◽

Pulmonary Nodule ◽

Ct Guidance ◽

Complication Rates ◽

Ct Fluoroscopy ◽

Procedural Time ◽

Patient Radiation Exposure ◽

Conventional Ct ◽

Fluoroscopy Guidance

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Computed Tomography-Guided Trans-scapular Coil Localization for Pulmonary Nodules

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1718772 ◽

2020 ◽

Author(s):

Jian-Hua Zhang ◽

Shi-Qing Zhou ◽

Feng-Fei Xia ◽

Tao Wang

Keyword(s):

Computed Tomography ◽

Success Rate ◽

Thoracoscopic Surgery ◽

Wedge Resection ◽

Pulmonary Nodules ◽

Technical Success ◽

Ct Guided ◽

Technical Success Rate ◽

Preoperative Ct ◽

Video Assisted Thoracoscopic Surgery

Abstract Background The aim of the study is to evaluate the feasibility, safety, and effectiveness of preoperative computed tomography (CT)-guided trans-scapular coil localization (TSCL) of scapula-blocked pulmonary nodules (PNs). Methods Between November 2015 and May 2020, 11 patients underwent preoperative CT-guided TSCL procedures owing to PN occlusion by scapula. Results A 100% technical success rate was achieved for CT-guided TSCL, with one coil being used for each PN. One patient (9.1%) developed pneumothorax. Successful video-assisted thoracoscopic surgery (VATS)-guided wedge resection of these scapula-blocked PNs was conducted in all patients. Conclusion CT-guided TSCL can be simply and safely used to facilitate successful VATS-guided wedge resection of scapula-blocked PNs.

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Trans-Scapular Approach Coil Localization for Scapular-Blocked Pulmonary Nodules: A Retrospective Study

10.21203/rs.3.rs-98967/v1 ◽

2020 ◽

Author(s):

Juan Wu ◽

Min-Ge Zhang ◽

Jin Chen ◽

Wen-Bin Ji

Keyword(s):

Success Rate ◽

Thoracoscopic Surgery ◽

Pulmonary Nodules ◽

Adenocarcinoma In Situ ◽

Technical Failure ◽

Technical Success ◽

Ct Guided ◽

Technical Success Rate ◽

Preoperative Ct ◽

The Mean

Abstract Background: Preoperative computed tomography (CT)-guided coil localization (CL) is commonly employed to facilitate the video-assisted thoracoscopic surgery (VATS)-guided diagnostic wedge resection (WR) of pulmonary nodules (PNs). When a scapular-blocked PN (SBPN) will be localized, the trans-scapular CL (TSCL) should be performed. In this study, we investigated the safety, feasibility, and clinical efficacy of preoperative CT-guided TSCL for SBPNs.Materials and Methods: From January 2014 to September 2020, a total of 152 patients with PNs underwent CT-guided CL prior to VATS-guided WR. Among them, 14 patients had the SBPNs and underwent TSCL procedure. Results: A total of 14 SBPNs were localized in the 14 patients. The mean diameter of the 14 SBPNs was 7.4 ± 2.4 mm. Technical success rate of puncture of the scapula was 100%. No complications occurred near the scapula. Technical success rate of CL was 92.9%. One coil dropped off when performing the VATS procedure. The mean duration of the TSCL was 14.2 ± 2.7 min. Two patient (14.3%) developed aysmptomatic pneumothorax after TSCL. Technical success rate of VATS-guided WR was 92.9%. The patient who experienced technical failure of TSCL directly underwent lobectomy. The mean VATS procedure duration and blood loss were 90.0 ± 42.4 min and 62.9 ± 37.2 ml, respectively. The final diagnoses of the 14 SBPNs included invasive adenocarcinoma (n = 4), adenocarcinoma in situ (n = 9), and benign (n = 1).Conclusions: Preoperative CT-guided TSCL can be safely and simply used to facilitate high successful rates of VATS-guided WR of SBPNs.

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A minimally fluoroscopic approach in AVNRT ablation reduces radiation exposure and number of RF applications without compromising safety, effectiveness and procedural time

EP Europace ◽

10.1093/europace/euab116.064 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

R Kasbari ◽

B Robaye ◽

F Dormal ◽

E Ballant ◽

B Collet ◽

...

Keyword(s):

Radiation Dose ◽

Radiation Exposure ◽

Conventional Group ◽

Complication Rates ◽

Reduce Radiation Exposure ◽

Acute Success ◽

Procedural Time ◽

Rf Applications ◽

Safety Effectiveness ◽

Mapping Systems

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Radiofrequency ablation (RF) of atrioventricular nodal reentry tachycardia (AVNRT) using conventional fluoroscopy is associated with a significant radiation exposure to both patients and operators. 3D electro-anatomical mapping systems (EAMS) can reduce radiation exposure, but specific clinical studies on their use in AVNRT ablation still lack. Purpose The aim of this study was to determine if EAMS use in AVNRT ablation can reduce radiation exposure and to analyse its effects on clinical and procedural outcomes. Methods We selected 277 patients who underwent AVNRT RF ablation in a single center in Belgium between July 2015 and November 2019 and performed a retrospective analysis of 136 and 141 patients who respectively and consecutively underwent AVNRT ablation with a conventional fluoroscopic approach (Conventional group) and a minimally fluoroscopic approach using a 3D electro-anatomical mapping system to guide the procedure (Minimal fluoroscopy group). Conventional fluoroscopy was used in both groups to confirm AVNRT induction to avoid costs related to the use of EAMS catheters in case of non-induction. We compared radiation dose, acute success/complication rates, procedural time and the number/time of RF applications in both groups. Results Radiation dose in the minimal fluoroscopy group was significantly lower compared to the conventional group (1179 vs. 2686 mgray.cm2, p < 0,0001) and fluoroscopic time was shorter (2,5 vs. 8,6 minutes, p < 0,0001). Procedural time (70 vs. 69 min, p = NS) and acute success rate (99% vs. 98%, p = NS) were not significantly different in the minimal fluoroscopy group compared to the conventional group, and no complications were observed in both groups. The number of RF applications was significantly lower when EAMS was used (6,2 ± 4,8 vs. 8,6 ± 7,6 RF application, p = 0,01) while the RF application time was not significantly different (56,8 ± 51,2 1 vs. 65,3 ± 86 seconds, p = NS). Conclusion AVNRT catheter ablation using a minimally fluoroscopic approach with 3D electro-anatomical mapping systems reduces radiation exposure without compromising safety, effectiveness and procedural time. EAMS use is associated with a reduction in the number of RF applications suggesting a higher precision and stability of ablation catheters during RF application.

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Uniportal VATS Coil-Assisted Resections for GGOs

Journal of Oncology ◽

10.1155/2019/5383086 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Maria Teresa Congedo ◽

Roberto Iezzi ◽

Dania Nachira ◽

Anna Rita Larici ◽

Marco Chiappetta ◽

...

Keyword(s):

Lung Resection ◽

Pulmonary Nodules ◽

Ground Glass ◽

Ct Guided ◽

Pleural Surface ◽

Preoperative Ct ◽

Mean Size ◽

Accurate Procedure ◽

The Mean ◽

Mixed Ground

Backgrounds. Although uniportal video-assisted thoracic surgery (VATS) theoretically allows the direct palpation of any zone of the lung through a small incision, sometimes it can be difficult to localize pure ground-glass opacities anyway. The aim of this study is to evaluate the usefulness and safety of preoperative computed tomography (CT)-guided microcoil localization of GGO nodules in patients undergoing uniportal VATS lung resection.Methods. The clinical data and CT images of 30 consecutive patients (30 pulmonary nodules) who underwent preoperative CT-guided coil localization and subsequent uniportal VATS resection, from January 2017 to October 2018, were reviewed.Results. All the CT-localization procedures have been performed with success (30/30) and the mean procedure time was 35±15 minutes. The mean size of the nodules was 15,53±6,72 mm, and the mean distance of the nodules from the pleural surface was 19,08±12,08 mm. Eleven nodules (36,7%) were pure ground-glass opacities and 19 (63,3%) were mixed ground-glass with a solid component of 50% or more. In 5 cases, the localization procedure was complicated by asymptomatic pneumothoraxes and in 1 case the pneumothorax required chest tube insertion. In any case a conversion to thoracotomy was avoided because all nodules were identified and resected through uniportal VATS.Conclusions. Preoperative CT-guided coil localization seems to be a feasible, safe, and accurate procedure. It makes uniportal VATS an easy approach even for resecting small, deep, and impalpable nodules.

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Propensity-matched analysis of general versus spinal anaesthesia for patients undergoing ankle fracture surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00451 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0045 ◽

Cited By ~ 1

Author(s):

David Sing ◽

Molly Vora ◽

Paul Tornetta

Keyword(s):

Length Of Stay ◽

Adverse Events ◽

General Anaesthesia ◽

Spinal Anaesthesia ◽

Ankle Fracture ◽

Operating Time ◽

Knee Surgery ◽

Complication Rates ◽

Improvement Program ◽

Hip And Knee Surgery

Category: Ankle Introduction/Purpose: The choice of anaesthesia is a modifiable risk factor in optimizing post-operative outcomes in hip and knee surgery, with decreased rates of transfusion, thromboembolic events, and infection with the use of spinal anaesthesia versus general anaesthesia. Regional anaesthesia has been evaluated with respect to its effect on early pain in patients undergoing ORIF of the ankle, but there is no data regarding complication rates. The purpose of this study was to compare operating time, length of stay, and rates of post-operative adverse events within 30-days in patients undergoing open reduction and internal fixation (ORIF) of the ankle using spinal vs. general anaesthesia. Methods: Adult patients who underwent ORIF of a closed ankle fracture from 2012 to 2016 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Patients who were operated on after admission from the ED are not included in the database. Operative time (skin to skin), length of stay, thirty-day adverse events, and unplanned readmissions were compared between patients who received general anaesthesia and those who received spinal anaesthesia. Propensity-adjustment with respect to known risk factors for complications and adjunctive regional block was used to match patients using a 1:4 ratio of spinal to general anaesthesia. Adverse events tracked included wound dehiscence, surgical site infection (superficial and deep), sepsis, venous thrombolic events, cardiac events, prolonged intubation, need for unplanned intubation, return to operating room, pneumonia, urinary tract infection, renal insufficiency, and re-admission within 30 days. Comparisons were performed using a propensity based multivariate analysis. Results: Of the 10,795 patients meeting inclusion criteria, 9,862 (91.4%) were treated with only general anaesthesia and 933 (8.6%) were treated with only spinal anaesthesia. Using propensity-scored matching, 822 patients in the spinal cohort were matched to 3,288 patients in the general cohort with similar baseline demographics (61.5% female, mean age 56.4). Procedure performed was similar in both cohorts (47% lateral malleolus ORIF, 34% bimalleolar ORIF, 10% trimalleolar ORIF, 8% medial malleolus ORIF, 1% posterior malleolus ORIF). Spinal anaesthesia was associated with increased length of stay (+0.5 days, 95% confidence interval (CI) 0.20-0.75, p<0.001) and increased mortality (0.6% vs 0.2%, OR: 4.02, 95% CI 1.15-14.1, p=0.03). Rates of overall complications (4.0% vs 4.2%) and readmissions (0.8% vs 0.7%) were similar and available in Table 1. Conclusion: General anaesthesia is predominantly used for fixation of ankle fractures. While spinal anaesthesia is associated with lower complication rates in hip and knee surgery, we found no advantage in patients undergoing ORIF of the ankle.

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A Simple Way to Indicate Pulmonary Nodules at Thoracoscopic Wedge Resections

Acta Radiologica ◽

10.1177/02841851960371p148 ◽

1996 ◽

Vol 37 (1P1) ◽

pp. 234-236

Author(s):

L. Denbratt ◽

J. Svanvik ◽

G. Rådberg

Keyword(s):

Steel Wire ◽

Pulmonary Nodules ◽

Cost Effective ◽

Minimal Invasive ◽

Thoracoscopic Resection ◽

Ct Guided ◽

Effective System ◽

Preoperative Ct ◽

Manual Palpation ◽

The Wire

Purpose: Small pulmonary subpleural nodules are sometimes difficult to localise at thoracotomy. With the advent of minimal invasive surgery, thoracoscopic resection avoiding anterolateral thoracotomy is an attractive procedure. Since this technique does not allow manual palpation, preoperative indication of lesions is mandatory. A simple and cost-effective system for preoperative CT-guided localisation of small subpleural nodules before thoracoscopic resection is described. Material and Methods: The system consists of a 0.2-mm steel wire 30–40 cm in length and a 0.9-mm biopsy needle. The tip of the wire is bent to a hook, and, guided by CT, it is placed in the vicinity of the lesion. The technique was tested in 8 cases. Results: The procedure was possible to perform in 7 patients. In all instances the wire remained in place when the lung was collapsed during the thoracoscopic procedure. The staple resected part of the lung also contained the lesion when examined extracorporeally. Conclusion: This simple and inexpensive system was found to be useful for indication of pulmonary lesions at thoracoscopic wedge resections.

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Computed tomography-guided preoperative localization of small lung nodules with indocyanine green

Acta Radiologica ◽

10.1177/0284185117733507 ◽

2017 ◽

Vol 59 (7) ◽

pp. 830-835 ◽

Cited By ~ 8

Author(s):

Keisuke Nagai ◽

Keiko Kuriyama ◽

Atsuo Inoue ◽

Yuriko Yoshida ◽

Koji Takami

Keyword(s):

Computed Tomography ◽

Indocyanine Green ◽

Pulmonary Nodules ◽

Preoperative Localization ◽

Lung Nodules ◽

Complication Rates ◽

Ct Guided ◽

Institutional Review ◽

Small Pulmonary Nodules ◽

Age Range

Background Small, deep-seated lung nodules and sub-solid nodules are often difficult to locate without marking. Purpose To evaluate the success and complication rates associated with the use of indocyanine green (ICG) to localize pulmonary nodules before resection. Material and Methods This retrospective study was approved by our institutional review board. Informed consent for performing preoperative localization using ICG marking was obtained from all patients. Thirty-seven patients (14 men, 23 women; mean age = 63.1 years; age range = 10–82 years) with small peripheral pulmonary nodules underwent computed tomography (CT)-guided ICG marking immediately before surgery between March 2007 and June 2016. The procedural details and complication rates associated with ICG marking are described. Results The average nodule size and depth were 9.1 mm (range = 2–22 mm) and 9.9 mm (range = 0–33 mm), respectively. Marking was detected at the pleural surface in 35 patients (95%). Three cases of mild pneumothorax (8%), five cases of cough (14%), and one case of mild bloody sputum (3%) with no clinical significance were noted. There were no severe complications. The average duration required to perform the marking was 19.4 min (range = 12–41 min). Conclusion Our results indicate that CT-guided ICG marking is safe and useful for detecting the location of small pulmonary nodules preoperatively.

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