Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series.
Cone-beam computed tomography
Hybrid operating room
Nodule localization
Sublobar resection
VATS
Journal
Journal of cardiothoracic surgery
ISSN: 1749-8090
Titre abrégé: J Cardiothorac Surg
Pays: England
ID NLM: 101265113
Informations de publication
Date de publication:
10 Feb 2024
10 Feb 2024
Historique:
received:
25
05
2023
accepted:
30
01
2024
medline:
11
2
2024
pubmed:
11
2
2024
entrez:
10
2
2024
Statut:
epublish
Résumé
Video-assisted thoracoscopic (VATS) lung resections are increasingly popular and localization techniques are necessary to aid resection. We describe our experience with hybrid operating room (OR) cone-beam computed tomography (CT) assisted pre-operative and intra-operative lesion localization of lung nodules for VATS wedge resections, including our novel workflow using the hybrid OR cone-beam CT to re-evaluate patients who have undergone pre-operative localization for those who are unsuitable for intra-operative localization. Retrospective analysis of all consecutive patients with small (≤ 20 mm), deep (≥ 10 mm distance from pleura) and/or predominantly ground-glass nodules selected for lesion localization in the Interventional Radiology suite followed by re-evaluation with cone-beam CT in the hybrid OR (pre-operative), or in the hybrid OR alone (intra-operative), prior to intentional VATS wedge performed by a single surgeon at our centre from January 2017 to December 2021. 30 patients with 36 nodules underwent localization. All nodules were successfully resected with a VATS wedge resection, although 10% of localizations had hookwire or coil dislodgement. The median effective radiation dose in the pre-operative group was 10.4 mSV including a median additional radiation exposure of 0.9 mSV in the hybrid OR for reconfirmation of hookwire or coil position prior to surgery (p = 0.87). The median effective radiation dose in the intra-operative group was 3.2 mSV with a higher mean rank than the intra-operative group, suggesting a higher radiation dose (p = 0.01). We demonstrate that our multidisciplinary approach utilizing the hybrid OR is safe and effective. Intra-operative localization is associated with lower radiation doses. Routine use of cone-beam CT to confirm the position of the physical marker prior to surgery in the hybrid OR helps mitigate consequences of localization failure with only a modest increase in radiation exposure.
Sections du résumé
BACKGROUND
BACKGROUND
Video-assisted thoracoscopic (VATS) lung resections are increasingly popular and localization techniques are necessary to aid resection. We describe our experience with hybrid operating room (OR) cone-beam computed tomography (CT) assisted pre-operative and intra-operative lesion localization of lung nodules for VATS wedge resections, including our novel workflow using the hybrid OR cone-beam CT to re-evaluate patients who have undergone pre-operative localization for those who are unsuitable for intra-operative localization.
METHODS
METHODS
Retrospective analysis of all consecutive patients with small (≤ 20 mm), deep (≥ 10 mm distance from pleura) and/or predominantly ground-glass nodules selected for lesion localization in the Interventional Radiology suite followed by re-evaluation with cone-beam CT in the hybrid OR (pre-operative), or in the hybrid OR alone (intra-operative), prior to intentional VATS wedge performed by a single surgeon at our centre from January 2017 to December 2021.
RESULTS
RESULTS
30 patients with 36 nodules underwent localization. All nodules were successfully resected with a VATS wedge resection, although 10% of localizations had hookwire or coil dislodgement. The median effective radiation dose in the pre-operative group was 10.4 mSV including a median additional radiation exposure of 0.9 mSV in the hybrid OR for reconfirmation of hookwire or coil position prior to surgery (p = 0.87). The median effective radiation dose in the intra-operative group was 3.2 mSV with a higher mean rank than the intra-operative group, suggesting a higher radiation dose (p = 0.01).
CONCLUSIONS
CONCLUSIONS
We demonstrate that our multidisciplinary approach utilizing the hybrid OR is safe and effective. Intra-operative localization is associated with lower radiation doses. Routine use of cone-beam CT to confirm the position of the physical marker prior to surgery in the hybrid OR helps mitigate consequences of localization failure with only a modest increase in radiation exposure.
Identifiants
pubmed: 38341594
doi: 10.1186/s13019-024-02564-7
pii: 10.1186/s13019-024-02564-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
85Informations de copyright
© 2024. The Author(s).
Références
Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening. N Engl J Med. 2011;365(5):395–409.
doi: 10.1056/NEJMoa1102873
Pedersen JH, Ashraf H. Implementation and organization of lung cancer screening. Ann Transl Med. 2016;4(8):152.
doi: 10.21037/atm.2016.03.59
pubmed: 27195270
pmcid: 4860485
Suzuki K, Watanabe S, Wakabayashi M, Moriya Y, Yoshino I, Tsuboi M, et al. A nonrandomized confirmatory phase III study of sublobar surgical resection for peripheral ground glass opacity dominant lung cancer defined with thoracic thin-section computed tomography (JCOG0804/WJOG4507L). J Clin Oncol. 2017;35(15Suppl):8561.
doi: 10.1200/JCO.2017.35.15_suppl.8561
Suzuki K, Watanabe S-i, Wakabayashi M, Saji H, Aokage K, Moriya Y, et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thoracic Cardiovas Surg. 2022;163(1):289-301.e2.
doi: 10.1016/j.jtcvs.2020.09.146
Ng CS, Rocco G, Wong RH, Lau RW, Yu SC, Yim AP. Uniportal and single-incision video-assisted thoracic surgery: the state of the art. Interact Cardiovasc Thorac Surg. 2014;19(4):661–6.
doi: 10.1093/icvts/ivu200
pubmed: 24994696
Suzuki K, Nagai K, Yoshida J, Ohmatsu H, Takahashi K, Nishimura M, et al. Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodules: indications for preoperative marking. Chest. 1999;115(2):563–8.
doi: 10.1378/chest.115.2.563
pubmed: 10027460
Chella A, Lucchi M, Ambrogi MC, Menconi G, Melfi FM, Gonfiotti A, et al. A pilot study of the role of TC-99 radionuclide in localization of pulmonary nodular lesions for thoracoscopic resection. Eur J Cardiothorac Surg. 2000;18(1):17–21.
doi: 10.1016/S1010-7940(00)00411-5
pubmed: 10869935
Chen YR, Yeow KM, Lee JY, Su IH, Chu SY, Lee CH, et al. CT-guided hook wire localization of subpleural lung lesions for video-assisted thoracoscopic surgery (VATS). J Formos Med Assoc. 2007;106(11):911–8.
doi: 10.1016/S0929-6646(08)60061-3
pubmed: 18063512
Hanauer M, Perentes JY, Krueger T, Ris H-B, Bize P, Schmidt S, et al. Pre-operative localization of solitary pulmonary nodules with computed tomography-guided hook wire: report of 181 patients. J Cardiothorac Surg. 2016;11(1):5.
doi: 10.1186/s13019-016-0404-4
pubmed: 26772183
pmcid: 4715360
Hsu H-H, Shen C-H, Tsai W-C, Ko K-H, Lee S-C, Chang H, et al. Localization of nonpalpable pulmonary nodules using CT-guided needle puncture. World J Surg Oncol. 2015;13(1):248.
doi: 10.1186/s12957-015-0664-9
pubmed: 26271476
pmcid: 4536773
Moon SW, Wang YP, Jo KH, Kwack MS, Kim SW, Kwon OK, et al. Fluoroscopy-aided thoracoscopic resection of pulmonary nodule localized with contrast media. Ann Thorac Surg. 1999;68(5):1815–20.
doi: 10.1016/S0003-4975(99)00764-X
pubmed: 10585064
Ordemann J, Gellert K, Rückert JC, Rogalla P, Müller JM. Localization of pulmonary nodules before thoracoscopic surgery: value of percutaneous staining with Indigocarmine Blue and CT-guided wire placement. Minim Invasive Ther Allied Technol. 1997;6(2):158–61.
doi: 10.3109/13645709709152723
Pang X, Xue L, Chen J, Ding J. A novel hybrid technique for localization of subcentimeter lung nodules. J Thorac Dis. 2017;9(4):1107–12.
doi: 10.21037/jtd.2017.03.75
pubmed: 28523166
pmcid: 5418267
Watanabe K, Nomori H, Ohtsuka T, Kaji M, Naruke T, Suemasu K. Usefulness and complications of computed tomography-guided lipiodol marking for fluoroscopy-assisted thoracoscopic resection of small pulmonary nodules: experience with 174 nodules. J Thorac Cardiovasc Surg. 2006;132(2):320–4.
doi: 10.1016/j.jtcvs.2006.04.012
pubmed: 16872957
Zhong L, Hu W, Li S, Wei Z, Zhu Z, Jin G, et al. Clinical study of video-assisted thoracoscopic surgery wedge resection in early-stage lung cancer by tumor mapping with indocyanine green. Wideochir Inne Tech Maloinwazyjne. 2019;14(4):545–50.
pubmed: 31908701
pmcid: 6939215
Thistlethwaite PA, Gower JR, Hernandez M, Zhang Y, Picel AC, Roberts AC. Needle localization of small pulmonary nodules: lessons learned. J Thorac Cardiovasc Surg. 2018;155(5):2140–7.
doi: 10.1016/j.jtcvs.2018.01.007
pubmed: 29455962
Chao YK, Fang HY, Pan KT, Wen CT, Hsieh MJ. Preoperative versus intraoperative image-guided localization of multiple ipsilateral lung nodules. Eur J Cardiothorac Surg. 2020;57(3):488–95.
pubmed: 31638653
Fang HY, Chen KA, Wen YW, Wen CT, Pan KT, Chiu CH, et al. Efficacy and safety of preoperative vs. intraoperative computed tomography-guided lung tumor localization: a randomized controlled trial. Front Surg. 2021;8:809908.
doi: 10.3389/fsurg.2021.809908
pubmed: 35071317
Hsieh CP, Hsieh MJ, Fang HY, Chao YK. Imaging-guided thoracoscopic resection of a ground-glass opacity lesion in a hybrid operating room equipped with a robotic C-arm CT system. J Thorac Dis. 2017;9(5):E416–9.
doi: 10.21037/jtd.2017.04.48
pubmed: 28616298
pmcid: 5465170
Zhao ZR, Lau RW, Yu PS, Wong RH, Ng CS. Image-guided localization of small lung nodules in video-assisted thoracic surgery. J Thorac Dis. 2016;8(Suppl 9):S731–7.
doi: 10.21037/jtd.2016.09.47
pubmed: 28066676
pmcid: 5179357
DoseWizard. Effective Dose Calculator - CTA Chest 2011 [Available from: https://www.dosewizard.com/2011/02/effective-dose-calculator-cta-chest.html .] Accessed 10 June 2022
Yang Z-J, Liang Y-H, Li M, Fang P. Preoperative computed tomography-guided coil localization of lung nodules. Minim Invasive Ther Allied Technol. 2020;29(1):28–34.
doi: 10.1080/13645706.2019.1576053
pubmed: 30712417
Kim YD, Jeong YJ, Hoseok I, Cho JS, Lee JW, Kim HJ, et al. Localization of pulmonary nodules with lipiodol prior to thoracoscopic surgery. Acta Radiol. 2011;52(1):64–9.
doi: 10.1258/ar.2010.100307
pubmed: 21498328
Lenglinger FX, Schwarz CD, Artmann W. Localization of pulmonary nodules before thoracoscopic surgery: value of percutaneous staining with methylene blue. AJR Am J Roentgenol. 1994;163(2):297–300.
doi: 10.2214/ajr.163.2.7518642
pubmed: 7518642
Nagai K, Kuriyama K, Inoue A, Yoshida Y, Takami K. Computed tomography-guided preoperative localization of small lung nodules with indocyanine green. Acta Radiol. 2018;59(7):830–5.
doi: 10.1177/0284185117733507
pubmed: 28971708
Hung CT, Chen CK, Chang YY, et al. Electromagnetic navigation-guided versus computed tomography-guided percutaneous localization of small lung nodules before uniportal video-assisted thoracoscopic surgery: a propensity score-matched analysis. Eur J Cardiothorac Surg. 2020;58(Suppl_1):i85–91.
doi: 10.1093/ejcts/ezz338
pubmed: 32105307
Park CH, Han K, Hur J, et al. Comparative effectiveness and safety of preoperative lung localization for pulmonary nodules: a systematic review and meta-analysis. Chest. 2017;151(2):316–28. https://doi.org/10.1016/j.chest.2016.09.017 .
doi: 10.1016/j.chest.2016.09.017
pubmed: 27717643
Kleedehn M, Kim DH, Lee FT, et al. Preoperative pulmonary nodule localization: a comparison of methylene blue and hookwire techniques. AJR Am J Roentgenol. 2016;207(6):1334–9. https://doi.org/10.2214/AJR.16.16272 .
doi: 10.2214/AJR.16.16272
pubmed: 27657546
Rostambeigi N, Scanlon P, Flanagan S, Frank N, Talaie R, Andrade R, et al. CT fluoroscopic-guided coil localization of lung nodules prior to video-assisted thoracoscopic surgical resection reduces complications compared to hook wire localization. J Vasc Interv Radiol. 2019;30(3):453–9.
doi: 10.1016/j.jvir.2018.10.013
pubmed: 30819493
Yi JH, Choi PJ, Bang JH, Jeong SS, Cho JH. Systemic air embolism after computed tomography-guided hook wire localization: two case reports and literature review. J Thorac Dis. 2018;10(1):E59–64. https://doi.org/10.21037/jtd.2017.12.04 .
doi: 10.21037/jtd.2017.12.04
pubmed: 29600106
pmcid: 5863141
Freund MC, Petersen J, Goder KC, Bunse T, Wiedermann F, Glodny B. Systemic air embolism during percutaneous core needle biopsy of the lung: frequency and risk factors. BMC Pulm Med. 2012;12:2. https://doi.org/10.1186/1471-2466-12-2 .
doi: 10.1186/1471-2466-12-2
pubmed: 22309812
pmcid: 3608336
Pietersen PI, Kristjansdottir B, Laursen C, Jørgensen GM, Graumann O. Systemic air embolism following computed-tomography-guided transthoracic needle biopsy of lung lesion - a systematic search of case reports and case series. Acta Radiol Open. 2022;11(6):20584601221096680. https://doi.org/10.1177/20584601221096680 .
doi: 10.1177/20584601221096680
pubmed: 35770135
pmcid: 9234839
Ng CS, Ong BH, Chao YK, Wright GM, Sekine Y, Wong I, et al. Use of indocyanine green fluorescence imaging in thoracic and esophageal surgery. Ann Thorac Surg. 2023;115(4):1068–76.
doi: 10.1016/j.athoracsur.2022.06.061
pubmed: 36030832
Patel S, Lindenberg M, Rovers MM, van Harten WH, Ruers TJM, Poot L, et al. Understanding the costs of surgery: a bottom-up cost analysis of both a hybrid operating room and conventional operating room. Int J Health Policy Manag. 2022;11(3):299–307.
pubmed: 32729284
Patrick J Lynch, C.Carl Jaffe. File: Lungs diagram simple.svg. Wikimedia Commons. [Available from: https://commons.wikimedia.org/w/index.php?curid=1496628 ]. Accessed 12 October 2022