Intraoperative Percutaneous Microcoil Localization of Small Peripheral Pulmonary Nodules Using Cone-Beam CT in a Hybrid Operating Room

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.

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The accuracy of cone-beam computed tomography and augmented fluoroscopy-guided bronchoscopic marking of multiple small-sized pulmonary nodules in a hybrid operating room: a retrospective cohort study

Quantitative Imaging in Medicine and Surgery ◽

10.21037/qims-20-781 ◽

2021 ◽

Vol 11 (2) ◽

pp. 725-736

Author(s):

Takashi Anayama ◽

Marino Yamamoto ◽

Kentaro Hirohashi ◽

Ryohei Miyazaki ◽

Hironobu Okada ◽

...

Keyword(s):

Computed Tomography ◽

Cohort Study ◽

Operating Room ◽

Cone Beam Computed Tomography ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Pulmonary Nodules ◽

Cone Beam ◽

Hybrid Operating Room

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MA02.04 Initial Experience of Hybrid Operating Room Cone-Beam CT Guided Bronchoscopic Microwave Thermal Ablation of Peripheral Small Lung Lesions

Journal of Thoracic Oncology ◽

10.1016/j.jtho.2021.01.208 ◽

2021 ◽

Vol 16 (3) ◽

pp. S134

Author(s):

J. Chan ◽

C. Ng ◽

P. Yu ◽

K. Lim ◽

I. Siu ◽

...

Keyword(s):

Operating Room ◽

Thermal Ablation ◽

Cone Beam Ct ◽

Cone Beam ◽

Initial Experience ◽

Hybrid Operating Room ◽

Ct Guided ◽

Lung Lesions

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Intraoperative cone beam CT in hybrid operating room set-up as an alternative to postoperative CT for pedicle screw breach detection

10.21203/rs.3.rs-256928/v1 ◽

2021 ◽

Author(s):

Simon Peh ◽

Julian Pfarr ◽

Jost Philipp Schäfer ◽

Jan-Hendrik Christensen ◽

Anindita Chatterjea ◽

...

Keyword(s):

Radiation Dose ◽

Pedicle Screw ◽

Operating Room ◽

Cone Beam Ct ◽

Pedicle Screws ◽

Roc Curves ◽

Cone Beam ◽

Screw Placement ◽

Hybrid Operating Room ◽

Effective Radiation Dose

Abstract Background CT is considered the gold standard for detecting pedicle breach. However, CBCT may be a viable and low radiation dose alternative, to provide intraoperative feedback to surgeons to permit in-room revisions of misplaced screws Methods To assess the ability and reliability of intraoperative cone-beam CT (CBCT) from a robotic C-arm in a hybrid operating room (OR) two hundred forty-one pedicle screws were inserted in cervical, thoracic and lumbar spine of 7 cadavers, followed by CBCT and CT imaging. The CT images served as the standard of reference. Agreement on screw placement between both imaging systems was assessed using Cohen’s Kappa coefficient (κ). Sensitivity, Specificity, Receiver operating characteristic (ROC), area under the empirical and fitted ROC curves (AUC) were computed to assess CBCT as a diagnostic tool compared to CT. The patient effective radiation dose (ED) was calculated for comparison. A systematic literature review was performed to provide perspective to the obtained results. Results Almost perfect agreement in assessing pedicle screw grading between CBCT and CT was observed (κ = 0.84). The sensitivity and specificity of CBCT were 0.84 and 0.98, respectively. The AUC derived from the empirical and fitted ROC curves were 0.95 and 0.96, respectively. Conclusion Intraoperative CBCT by C-arm in a hybrid OR is highly reliable in identification of screw placement at significant dose reduction.

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Ciliated muconodular papillary tumor with a growing cavity shadow that mimicked colorectal metastasis to the lung: a case report

Surgical Case Reports ◽

10.1186/s40792-020-01012-7 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Kotaro Murakami ◽

Yojiro Yutaka ◽

Naoki Nakajima ◽

Akihiko Yoshizawa ◽

Hiroshi Date

Keyword(s):

Colorectal Cancer ◽

Operating Room ◽

Lung Tumor ◽

Cone Beam Ct ◽

Cone Beam ◽

Small Lesion ◽

Hybrid Operating Room ◽

Papillary Tumor ◽

Preoperative Marking ◽

Dye Marking

Abstract Background Ciliated muconodular papillary tumor (CMPT) is a rare papillary nodule tumor with benign and malignant characteristics that occurs in the peripheral lung. Case presentation A 70-year-old woman who underwent right hemicolectomy for colorectal cancer (CRC; pT3N0M0, p-stage II) 2 years prior, presented with a sub-centimeter growing cavity shadow on chest computed tomography (CT), which was suspected to be a CRC metastasis. Because positron emission tomography CT suggested there was no other site suspicious of recurrence, thoracoscopic resection with preoperative pleural dye marking was planned to remove the small lesion, which seemed to be hardly palpable on CT. Immediately after pleural dye marking adjacent to the lesion using cone beam CT in the hybrid operating room, thoracoscopic wedge resection was performed and the tumor was finally diagnosed as CMPT, characterized by the papillary growth of mucus-producing cells in the alveoli. Conclusion We resected the non-palpable small lung lesions following preoperative marking using cone-beam CT in the hybrid operating room. This case highlights a rare cavitary CT image of a CMPT mimicking a metastatic lung tumor from colorectal cancer.

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

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz360 ◽

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).

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