Peripheral Lung Nodules
| Autor: | Harvey O. Coxson, Richard J. Finley, Tom I. Powell, Neal Church, D. Jangra, Kenneth G. Evans, Humberto Lara-Guerra, Joanne Clifton, John C. English, John R. Mayo, John Yee |
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| Rok vydání: | 2004 |
| Předmět: |
Male
medicine.medical_specialty Lung Neoplasms medicine.medical_treatment Microcoil Radiography Interventional Original Articles and Discussions Preoperative Care medicine Thoracoscopy Humans Fluoroscopy Lung Platinum Solitary pulmonary nodule medicine.diagnostic_test Thoracic Surgery Video-Assisted business.industry Solitary Pulmonary Nodule Nodule (medicine) Middle Aged medicine.disease Hemothorax Chest tube Pneumothorax Female Surgery Radiology medicine.symptom Tomography X-Ray Computed business |
| Zdroj: | Annals of Surgery. 240:481-489 |
| ISSN: | 0003-4932 |
| Popis: | Objectives: We sought to test the safety and efficacy of fluoroscopically guided, video-assisted, thoracoscopic resection after computed tomography (CT)-guided localization using platinum microcoils. Summary Background Data: Video-assisted thoracoscopic (VATS) resection of small pulmonary nodules 5 mm deep to the visceral pleura fails to locate the nodule and requires conversion to open thoracotomy in two thirds of cases. Therefore, we developed a new technique for intraoperative localization of these nodules using CTguided placement of platinum microcoils. This study tests the safety and efficacy of this technique in a Phase I human study. Methods: Twelve patients with undiagnosed growing pulmonary nodules 20 mm were marked preoperatively using percutaneously placed CT-guided platinum microcoils. The coil was deployed adjacent to the nodule with the distal end of the coil placed deep to the nodule and the superficial end coiled on the pleural surface. The nodule and coil were excised using endostaplers guided by VATS and fluoroscopy. Histopathologic diagnosis was performed immediately after resection. Results: CT-guided microcoil localization was successful in all patients. A small hemothorax and a pneumothorax requiring a chest tube occurred in 2 patients. Mean distance from visceral pleura to the deep edge of the nodule was 30.9 15.4 mm. VATS resection of the nodules (size 11.8 3.2mm) was successful in all patients. Mean microcoil localization, fluoroscopy, and operative times were 42 14, 3.1 2.0, and 67 27 minutes. A diagnosis of primary nonsmall cell bronchogenic carcinoma was made in 6 patients who then received a completion lobectomy. Six patients (hamartoma: 2, reactive lymph node: 1, bronchoalveolar cell carcinoma: 2, metastatic sarcoma: 1) did not receive further resections. Conclusions: Preoperative localization of pulmonary nodules using percutaneous CT-guided platinum microcoil insertion combined with operative fluoroscopic visualization is a safe, effective technique that increases the success rate of VATS excision. |
| Databáze: | OpenAIRE |
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