Single-Stage Localization and Thoracoscopic Removal of Nonpalpable Pulmonary Nodules in a Hybrid Operating Room
| Autor: | Alessandro Locatelli, Giulio Melloni, Alberto Balderi, Federico Mazza, Massimiliano Venturino, Davide Turello, Enrico Peano |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Operating Rooms Lung Neoplasms business.industry Single stage Thoracic Surgery Video-Assisted medicine.medical_treatment Solitary Pulmonary Nodule General Medicine medicine.disease Video-assisted thoracoscopic surgery medicine Hybrid operating room Humans Multiple Pulmonary Nodules Surgery Radiology Cardiology and Cardiovascular Medicine Lung cancer business Pneumonectomy Tomography X-Ray Computed |
| Zdroj: | Innovations (Philadelphia, Pa.). 15(6) |
| ISSN: | 1559-0879 |
| Popis: | 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 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. |
| Databáze: | OpenAIRE |
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