Single-Stage Localization and Thoracoscopic Removal of Nonpalpable Pulmonary Nodules in a Hybrid Operating Room

2020 ◽  
Vol 15 (6) ◽  
pp. 555-562
Author(s):  
Federico Mazza ◽  
Massimiliano Venturino ◽  
Enrico Peano ◽  
Alberto Balderi ◽  
Davide Turello ◽  
...  
Keyword(s):  
Operating Room ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Pulmonary Nodules ◽  
Lesion Size ◽  
Future Research ◽  
Surgical Removal ◽  
Hybrid Operating Room ◽  
Nonpalpable Lesions ◽  
The Mean

Objective We report our experience with simultaneous localization and thoracoscopic removal for nonpalpable undiagnosed pulmonary nodules. Methods All patients with nonpalpable lesions requiring video-assisted thoracoscopic surgery (VATS) wedge resection underwent localization of the targets and surgical removal in a hybrid operating room. Lesions were considered nonpalpable if they were small (<1 cm), deep (>1 cm from the surface), subsolid, or located within a dystrophic area. In all cases, intraoperative cone-beam computed tomography was performed for nodule localization and targeting, metal hookwires, or coils were alternatively used for intraoperative marking. Results From April 2016 to November 2019, 39 image-guided VATS (iVATS) were performed. The mean lesion size was 12 ± 6 mm. The mean distance from the deep edge of the lesion to the pleural surface was 24 ± 9 mm. The localization was performed with 20 hookwires and 19 coils. iVATS localization was successful in 36 patients (92.3%). Thirty-seven wedge resections were completed by VATS, 2 (5%) required conversion to thoracotomy. In 9 patients with intraoperative diagnosis of lung cancer, a lobectomy was performed (7 VATS and 2 thoracotomies). Mean length of iVATS localization was 30 ± 13 minutes. Median postoperative length of stay was 4 days (IQR 3 to 5). Conclusions iVATS seems to be a helpful tool for simultaneous localization and removal of nonpalpable nodules. A versatile approach using different devices seems advisable for the removal of targets in every clinical scenario reducing VATS conversion rate. Future research is required to compare iVATS with traditional preoperative localization techniques.

scholarly journals Combined lipiodol marking and video-assisted thoracoscopic surgery in a hybrid operating room

2018 ◽  
Vol 10 (5) ◽  
pp. 2940-2947 ◽  
Author(s):  
Satoshi Fumimoto ◽  
Kiyoshi Sato ◽  
Mitsuhiro Koyama ◽  
Kazuhiro Yamamoto ◽  
Yoshifumi Narumi ◽  
...  
Keyword(s):  
Operating Room ◽  
Thoracoscopic Surgery ◽  
Hybrid Operating Room ◽  
Video Assisted ◽  
Lipiodol Marking ◽  
Video Assisted Thoracoscopic Surgery

scholarly journals Hybrid Operating Room System for the Treatment of Thoracic and Abdominal Aortic Aneurysms: Evaluation of the Radiation Dose Received by Patients

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 846
Author(s):  
Yoshihiro Haga ◽  
Koichi Chida ◽  
Masahiro Sota ◽  
Yuji Kaga ◽  
Mitsuya Abe ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Operating Room ◽  
Radiation Effects ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Hybrid Operating Room ◽  
Promising Alternative ◽  
Dose Area Product ◽  
Aortic Repair ◽  
The Mean

In recent years, endovascular treatment of aortic aneurysms has attracted considerable attention as a promising alternative to traditional surgery. Hybrid operating room systems (HORSs) are increasingly being used to perform endovascular procedures. The clinical benefits of endovascular treatments using HORSs are very clear, and these procedures are increasing in number. In procedures such as thoracic endovascular aortic repair (TEVAR) and endovascular aortic repair (EVAR), wires and catheters are used to deliver and deploy the stent graft in the thoracic/abdominal aorta under fluoroscopic control, including DSA. Thus, the radiation dose to the patient is an important issue. We determined radiation dose indicators (the dose–area product (DAP) and air karma (AK) parameters) associated with endovascular treatments (EVAR and TEVAR) using a HORS. As a result, the mean ± standard deviation (SD) DAPs of TEVAR and EVAR were 323.7 ± 161.0 and 371.3 ± 186.0 Gy × cm2, respectively. The mean ± SD AKs of TEVAR and EVAR were 0.92 ± 0.44 and 1.11 ± 0.54 Gy, respectively. The mean ± SD fluoroscopy times of TEVAR and EVAR were 13.4 ± 7.1 and 23.2 ± 11.7 min, respectively. Patient radiation dose results in this study of endovascular treatments using HORSs showed no deterministic radiation effects, such as skin injuries. However, radiation exposure during TEVAR and EVAR cannot be ignored. The radiation dose should be evaluated in HORSs during endovascular treatments. Reducing/optimizing the radiation dose to the patient in HORSs is important.

scholarly journals Real-time image-guided electromagnetic navigation bronchoscopy dual-marker technique to localize deep pulmonary nodules in a hybrid operating room

2020 ◽  
Vol 58 (Supplement_1) ◽  
pp. i103-i105
Author(s):  
Chuan Cheng ◽  
Hsin-Yueh Fang ◽  
Chih-Tsung Wen ◽  
Yin-Kai Chao
Keyword(s):  
Operating Room ◽  
Near Infrared ◽  
Pulmonary Nodules ◽  
Surface Marker ◽  
Hybrid Operating Room ◽  
Electromagnetic Navigation ◽  
Image Guided ◽  
Real Time Image ◽  
Near Infrared Dye ◽  
Time Image

Abstract Herein, we describe a Dyna-computed tomography-guided electromagnetic navigation bronchoscopy technique aimed at localizing deep pulmonary nodules. The method was implemented in a hybrid operating room and required the use of 2 markers (a near-infrared dye as a surface marker and a microcoil as a deep marker).

scholarly journals Role of Hybrid Operating Room: Present and Future

2020 ◽  
Author(s):  
Evan Qize Yuan ◽  
Calvin Sze Hang Ng
Keyword(s):  
Thoracic Surgery ◽  
Operating Room ◽  
Early Stage ◽  
Intraoperative Imaging ◽  
Cone Beam Ct ◽  
Pulmonary Nodules ◽  
High Definition ◽  
Hybrid Operating Room ◽  
Invasive Treatment ◽  
Patient Groups

With the dramatic progress of medical imaging modalities and growing needs for high-resolution intraoperative imaging in minimally invasive surgery, hybrid operative room (OR) has been developed as a powerful tool for different surgical scenarios. Under the guidance of high-definition cone beam CT (CBCT), an electromagnetic navigation bronchoscopy (ENB)-based marker implantation and subsequent localization of the pulmonary nodules can be implemented within a hybrid OR. Furthermore, the unparalleled real-time imaging capabilities and the ability to perform multiple tasks within the hybrid OR can facilitate image-guided single-port video-assisted thoracic surgery (iSPVATS), increasing the precision and improving outcomes of the procedure. With the help of a hybrid theatre, catheter-based thermal ablation can provide a safer and less invasive treatment option for select patient groups with early-stage non-small cell lung carcinomas (NSCLC) or metastases. In the future, the combination of hybrid operating room and other inspiring innovative techniques, such as robotic bronchoscopy, 3D-printing, natural orifice transluminal endoscopic surgery (NOTES) lung surgery could lead to a paradigm shift in the way thoracic surgery is conducted.

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):  
Computed Tomography ◽  
Methylene Blue ◽  
Thoracic Surgery ◽  
Wedge Resection ◽  
Pulmonary Nodules ◽  
Tactile Sensation ◽  
Wire Localization ◽  
Pathologic Diagnosis ◽  
History Of ◽  
The Mean

Objective Because of decreased tactile sensation with thoracoscopic approaches to biopsy, localization preoperatively and intraoperatively is important for successful biopsy. Our study evaluated the technique of combined computed tomography-guided hookwire and methylene blue localization. Methods Seventy-five patients from November 2007 to August 2013 who underwent combined Hawkins hookwire and methylene blue localization of 76 total pulmonary nodules before video-assisted thoracic surgery-guided wedge resection were retrospectively reviewed. Multiple patient, nodule, and procedural characteristics were analyzed for correlation with successful wire localization and wire dislodgement. Successful wire localization was defined as absence of lesions requiring re-resection, wire dislodgement necessitating re-resection, or conversion to thoracotomy for localization. Results Seventy-four patients were included in the study (75 pulmonary nodules - 1 patient had 2 lesions localized) and mean ± SD patient age was 65.8 ± 12.1 years and 50% were male. The mean ± SD largest nodule diameter was 14.6 ± 7.4 mm and 29.3% of these were subcentimeter pulmonary nodules. Increased age and history of malignancy were associated with malignant diagnoses ( P = 0.037 and 0.009, respectively) Successful wire localization was present in 86.4% of patients. Lesions with lower mean distance to the pleura correlated with successful localization ( P = 0.002). Wire dislodgement was present in 9.3% (7 patients) with 4 (5.3%) of these necessitating need for re-resection to establish pathologic diagnosis. Albeit wire dislodgement, 57.4% (4/7) still had successful thoracoscopic localization. Conclusions This study demonstrates that utilization of Hawkins hookwire in combination with methylene blue injection is an effective method to successfully localize pulmonary nodules for thoracoscopic wedge resection and should prompt further investigation for its utilization.

scholarly journals Can Awake Thoracoscopy Procedure be Performed with the Help of Thoracic Paravertebral Anesthesia?

2018 ◽  
Vol 17 (4) ◽  
pp. 576-582
Author(s):  
Fazli Yanik ◽  
Yekta Altemur Karamustafaoglu ◽  
Elif Copuruoglu ◽  
Gonul Sagiroglu
Keyword(s):  
Hospital Stay ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Medical Science ◽  
Oral Intake ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Early Mobilization ◽  
Talc Pleurodesis ◽  
The Mean

Aim:The aim of this study was to present our experience with 11 patients who were spontaneously breathing with Awake Video Thoracoscopy (AVATS) procedure with the help of TPB because of rareness in the literature.Materials and Methods: Between December 2015 and December 2017, a total of 125 VATS cases were performed; 11 cases underwent VATS operation with the help of TPB; age, gender, operation performed, duration of operation, time of onset of mobilization-oral intake, duration of hospital stay, Visual Analogue Scale (VAS) scores were evaluated retrospectively.Results: All cases were treated with uniportal AVATS procedure with the help of TPB. The mean age was 40,3 ± 17,4 years (range 18-64 years ), nine (82%) of the pateints were male and two (18%) were female. Operation procedures included wedge resection in eight (73 %) patients (six of them for pneumothorax, two of them for diagnosis), in three (27%) patients pleural biopsy (one of them used talc pleurodesis).There were no perioperative events. The mean operation time was 27,7 ± 6,4 minutes (range, 20-40 min) and the mean anesthesia time was 25 ± 3,8 minutes (range 20-30 min).The mean time of mobilizitation, oral intake opening time and length of hospital stay was 1,1 ± 0,4 hours (1-2 hours), 3,5 ± 0,5 hours (3-4 hours), 2,6 ± 0,5 days (2-3 days), respectively.Conclusion:Awake Video Asssited Thoracoscopic Surgery with the help of TPB has less side effects and less complication risks than other awake procedures with the help of other regional anesthesia techniques. We conclude that; although AVATS with the help of TPB has some minor complications, it has advantages such as early discharge, early mobilization and early oral intake, low pain levels in well-selected patient groups.Bangladesh Journal of Medical Science Vol.17(4) 2018 p.576-582

scholarly journals Image-guided thoracoscopic surgery with dye localization in a hybrid operating room

2016 ◽  
Vol 8 (S9) ◽  
pp. S681-S689 ◽  
Author(s):  
Shun-Mao Yang ◽  
Wei-Chun Ko ◽  
Mong-Wei Lin ◽  
Hsao-Hsun Hsu ◽  
Chih-Yang Chan ◽  
...  
Keyword(s):  
Operating Room ◽  
Thoracoscopic Surgery ◽  
Hybrid Operating Room ◽  
Image Guided

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

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.

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

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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