Benefits of Electromagnetic Navigational Bronchoscopy for Identifying Pulmonary Nodules for Robotic Resections

2017 ◽  
Vol 12 (6) ◽  
pp. 418-420 ◽  
Author(s):  
Stevan S. Pupovac ◽  
Alexander Chaudhry ◽  
Vijay A. Singh
Keyword(s):  
Methylene Blue ◽  
Minimally Invasive ◽  
Pulmonary Resection ◽  
Pulmonary Nodules ◽  
Combined Approach ◽  
Robotic Approach ◽  
Combined Procedure ◽  
Thoracic Approach ◽  
Dye Marking ◽  
Electromagnetic Navigational Bronchoscopy

Objective The ability to localize pulmonary nodules via the robotic thoracic technique can be challenging at times. This is most evident when nodules are small and/or ground glass in nature. Information regarding methods available to localize these difficult nodules, while maintaining a minimally invasive robotic approach, is limited. Methods We describe a diagnostic and therapeutic method of combining electromagnetic navigational bronchoscopy with a total minimally invasive robotic approach that identifies these difficult-to-localize pulmonary nodules. The technique entails the use of electromagnetic navigational bronchoscopy to place a pleural dye marker with a subsequent pulmonary resection via a robotic thoracic approach. Results A cohort of 15 patients from August 2014 to December 2015 was reviewed. These patients underwent the combined approach of electromagnetic navigational bronchoscopy followed by a robotic pulmonary resection. Fourteen of the 15 patients had a successful combined procedure, which was confirmed with pathology. The range of the nodules was 0.8 to 2 cm. Methylene blue was used for pleural dye marking. On one occasion, the pleural dye was not able to be deciphered. There were no complications from either the electromagnetic navigational bronchoscopy or robotic portions of the procedure. Conclusions Pleural dye marking via electromagnetic navigational bronchoscopy can provide an effective method for localizing pulmonary nodules, while maintaining a minimally invasive robotic approach. This tactic allows one to obtain diagnostic tissue more efficiently, while limiting the potential inability to localize a nodule.

Electromagnetic navigational bronchoscopy-directed dye marking for locating pulmonary nodules

2020 ◽  
Vol 96 (1141) ◽  
pp. 674-679
Author(s):  
Long-long Wang ◽  
Bi-fang He ◽  
Jing-hua Cui ◽  
Xing-lin Gao ◽  
Ping-ping Chen ◽  
...  
Keyword(s):  
Guide Wire ◽  
Pulmonary Nodules ◽  
Resection Margins ◽  
Ct Guided ◽  
Pleural Surface ◽  
Visual Markers ◽  
Registration Number ◽  
The Mean ◽  
Dye Marking ◽  
Electromagnetic Navigational Bronchoscopy

BackgroundSmall peripheral pulmonary nodules, which are usually deep-seated with no visual markers on the pleural surface, are often difficult to locate during surgery. At present, CT-guided percutaneous techniques are used to locate pulmonary nodules, but this method has many limitations. Thus, we aimed to evaluate the accuracy and feasibility of electromagnetic navigational bronchoscopy (ENB) with pleural dye to locate small peripheral pulmonary nodules before video-associated thoracic surgery (VATS).MethodsThe ENB localisation procedure was performed under general anaesthesia in an operating room. Once the locatable guide wire, covered with a sheath, reached the ideal location, it was withdrawn and 0.2–1.0 mL of methylene blue/indocyanine green was injected through the guide sheath. Thereafter, 20–60 mL of air was instilled to disperse the dye to the pleura near the nodules. VATS was then performed immediately.ResultsStudy subjects included 25 patients with 28 nodules. The mean largest diameter of the pulmonary nodules was 11.8 mm (range, 6.0–24.0 mm), and the mean distance from the nearest pleural surface was 13.4 mm (range, 2.5–34.9 mm). After the ENB-guided localisation procedure was completed, the dye was visualised in 23 nodules (82.1%) using VATS. The average duration of the ENB-guided pleural dye marking procedure was 12.6 min (range, 4–30 min). The resection margins were negative in all malignant nodules. Complications unrelated to the ENB-guided localisation procedure occurred in two patients, including one case of haemorrhage and one case of slow intraoperative heart rate.ConclusionENB can be used to safely and accurately locate small peripheral pulmonary nodules and guide surgical resection.Trial registration numberChiCTR1900021963.

Electromagnetic Navigational Bronchoscopy Reduces the Time Required for Localization and Resection of Lung Nodules

2017 ◽  
Vol 12 (5) ◽  
pp. 333-337 ◽  
Author(s):  
William David Bolton ◽  
Thomas Cochran ◽  
Sharon Ben-Or ◽  
James E. Stephenson ◽  
William Ellis ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Minimally Invasive ◽  
Surgical Resection ◽  
Pulmonary Nodules ◽  
Wait Time ◽  
Significant Difference ◽  
The Difference ◽  
Time Required ◽  
Small Pulmonary Nodules ◽  
Electromagnetic Navigational Bronchoscopy

Objective The aims of the study were to evaluate electromagnetic navigational bronchoscopy (ENB) and computed tomography–guided placement as localization techniques for minimally invasive resection of small pulmonary nodules and determine whether electromagnetic navigational bronchoscopy is a safer and more effective method than computed tomography–guided localization. Methods We performed a retrospective review of our thoracic surgery database to identify patients who underwent minimally invasive resection for a pulmonary mass and used either electromagnetic navigational bronchoscopy or computed tomography–guided localization techniques between July 2011 and May 2015. Results Three hundred eighty-three patients had a minimally invasive resection during our study period, 117 of whom underwent electromagnetic navigational bronchoscopy or computed tomography localization (electromagnetic navigational bronchoscopy = 81; computed tomography = 36). There was no significant difference between computed tomography and electromagnetic navigational bronchoscopy patient groups with regard to age, sex, race, pathology, nodule size, or location. Both computed tomography and electromagnetic navigational bronchoscopy were 100% successful at localizing the mass, and there was no difference in the type of definitive surgical resection (wedge, segmentectomy, or lobectomy) ( P = 0.320). Postoperative complications occurred in 36% of all patients, but there were no complications related to the localization procedures. In terms of localization time and surgical time, there was no difference between groups. However, the down/wait time between localization and resection was significant (computed tomography = 189 minutes; electromagnetic navigational bronchoscopy = 27 minutes); this explains why the difference in total time (sum of localization, down, and surgery) was significant ( P < 0.001). Conclusions We found electromagnetic navigational bronchoscopy to be as safe and effective as computed tomography–guided wire placement and to provide a significantly decreased down time between localization and surgical resection.

CT Fluoroscopy-Guided Bronchoscopic Dye Marking for Resection of Small Peripheral Pulmonary Nodules

CHEST Journal ◽  
2004 ◽  
Vol 125 (5) ◽  
pp. 1747-1752 ◽  
Author(s):  
Masahiro Endo ◽  
Yoshikazu Kotani ◽  
Miyako Satouchi ◽  
Yoshiki Takada ◽  
Toshihiko Sakamoto ◽  
...  
Keyword(s):  
Pulmonary Nodules ◽  
Ct Fluoroscopy ◽  
Dye Marking

Preoperative Computed Tomography-Guided Localization for Pulmonary Nodules with Glue and Dye

2020 ◽  
Vol 68 (06) ◽  
pp. 525-532
Author(s):  
Tian Jiang ◽  
Miao Lin ◽  
Mengnan Zhao ◽  
Cheng Zhan ◽  
Ming Li ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Methylene Blue ◽  
Success Rate ◽  
Complication Rate ◽  
Lung Resection ◽  
Surgical Margin ◽  
Pulmonary Nodules ◽  
Blue Dye ◽  
Methylene Blue Dye ◽  
Ct Guided

Abstract Background This study was aimed to describe a new localization technique developed using medical glue and methylene blue dye, and characterized the localization results and postoperative outcome to evaluate its safety and usefulness. Methods This retrospective study was conducted at our center from January 2016 to April 2018. Totally 346 consecutive patients with 383 nodules who underwent preoperative computed tomography (CT)-guided medical glue and methylene blue dye localization, followed by lung resection, were enrolled in this study. Results Mean nodule size was 7.7 ± 3.7 mm (range: 2–30 mm), with a mean depth from pleura or fissure of 9.4 ± 9.3 mm (range: 0–60 mm). The success rate of CT-guided localization for pulmonary nodules was 99.5% (381/383) of the nodules. Localization-related complications included mild pneumothorax in 16 (4.6%) patients, mild hemothorax in 7 (2.0%) patients, and hemoptysis in 1 (0.3%) patient. Pleural reaction occurred in 7 (2.0%) and pain in 25 (7.2%) patients. All 383 nodules were resected successfully, with conversion to thoracotomy only required in two patients for adhesion and calcification of lymph nodes. All patients recovered well postoperatively, with a short postoperative hospital stay (3.7 ± 2.0 days) and a low complication rate (2.6%, 9/346). Conclusion CT-guided medical glue and methylene blue dye localization prior to video-assisted thoracoscopic surgery (VATS) lung resection was a novel, safe, and technically feasible method, with a high-technical success rate and a low-complication rate. It allowed surgeons to easily locate and detect the nodules and estimate the surgical margin.

scholarly journals Pre-emptive pain management program is associated with reduction of opioid prescription after minimally invasive pulmonary resection

2020 ◽  
Vol 12 (5) ◽  
pp. 1982-1990
Author(s):  
Haydee Del Calvo ◽  
Duc T. Nguyen ◽  
Leonora M. Meisenbach ◽  
Ray Chihara ◽  
Edward Y. Chan ◽  
...  
Keyword(s):  
Pain Management ◽  
Minimally Invasive ◽  
Pulmonary Resection ◽  
Management Program ◽  
Opioid Prescription ◽  
Pain Management Program

Combined Hookwire and Methylene Blue Localization of Pulmonary Nodules

2018 ◽  
Vol 13 (3) ◽  
pp. 184-189 ◽  
Author(s):  
John Joseph Brady ◽  
Christie Hirsch Reilly ◽  
Robert Guay ◽  
Uday Dasika
Keyword(s):  
Methylene Blue ◽  
Pulmonary Nodules

scholarly journals A meta-analysis of preoperative bronchoscopic marking for pulmonary nodules

2020 ◽  
Vol 58 (1) ◽  
pp. 40-50 ◽  
Author(s):  
Masahiro Yanagiya ◽  
Takuya Kawahara ◽  
Keiko Ueda ◽  
Daisuke Yoshida ◽  
Hirokazu Yamaguchi ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Pulmonary Nodules ◽  
Pulmonary Haemorrhage ◽  
Cochrane Library ◽  
Complication Rates ◽  
Resection Rate ◽  
Electromagnetic Navigation ◽  
Meta Analyses ◽  
Dye Marking ◽  
Pleural Injury

Abstract OBJECTIVES Recent studies have suggested the usefulness of preoperative bronchoscopic marking techniques for the localization of pulmonary nodules in thoracic surgery. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of preoperative bronchoscopic marking. METHODS The PubMed and Cochrane Library databases were searched for clinical studies evaluating preoperative bronchoscopic marking for pulmonary resection. Non-comparative and random effects model-based meta-analyses were conducted to calculate the pooled success and complication rates of bronchoscopic marking. RESULTS Twenty-five eligible studies were included. Among these, 15 studies conducted dye marking under electromagnetic navigation bronchoscopy, 4 used virtual-assisted lung mapping and 7 used other marking methods. The overall pooled successful marking rate, successful resection rate and complete resection rate were 0.97 [95% confidence interval (CI) 0.95–0.99], 0.98 (95% CI 0.96–1.00) and 1.00 (95% CI 1.00–1.00), respectively. The overall pooled rates of pleural injury and pulmonary haemorrhage were 0.02 (95% CI 0.01–0.05) and 0.00 (95% CI 0.00–0.00), respectively. CONCLUSIONS This meta-analysis demonstrated that bronchoscopic marking is very safe and effective. Bronchoscopic marking should be considered, especially if there are concerns about the safety of other localization methods.

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