Yang Shun-Mao, Ko Wei-Chun, Lin Mong-Wei, Hsu Hsao-Hsun, Chan Chih-Yang, Wu I-Hui, Chang Yeun-Chung, Chen Jin-Shing
Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan;; Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
J Thorac Dis. 2016 Oct;8(Suppl 9):S681-S689. doi: 10.21037/jtd.2016.09.55.
The rate of detection of small pulmonary nodules (SPNs) has increased. Thoracoscopic resection following image-guided localization had been a reliable alternative in their treatment. We present our experience with image-guided dye localization using robotic C-arm computed tomography (CT) followed by immediate video-assisted thoracoscopic surgery (VATS) for SPNs in a hybrid operating room (OR).
From July 2015 to July 2016, 25 consecutive patients with SPNs smaller than 2 cm underwent robotic C-arm CT-guided blue dye tattooing followed by immediate VATS in a hybrid OR. Their medical records were retrospectively reviewed to evaluate the feasibility and safety of this novel procedure.
Robotic C-arm CT-guided dye localization was successfully performed in 23 patients (92%). Wound extension was required for nodule identification in the remaining two patients. The median size of the nodules was 1.0 cm (range, 0.6-2.0 cm). The median needle localization time and surgery time were 46 and 109 min, respectively. All 25 patients had successful resection of their lesions. The pathological diagnoses were primary lung adenocarcinoma in 18 (72%), benign tumors in 5 (20%), and metastatic lesions in 2 (8%). There was no operative mortality. The median length of the postoperative stay was 3 days (range, 2-8 days). Complications were noted in two patients (8%). One patient had a penetrating injury of the diaphragm during needle localization. The other had pneumonia postoperatively. Both patients were managed conservatively.
Our experience showed that robotic C-arm CT-guided dye localization followed by immediate thoracoscopic surgery in a hybrid OR is safe and feasible. It may become an effective and attractive alternative in managing SPNs.
小肺结节（SPN）的检出率有所上升。影像引导下定位后行胸腔镜切除术一直是其治疗的可靠选择。我们介绍在杂交手术室中使用机器人C臂计算机断层扫描（CT）进行影像引导下染料定位，随后立即行电视辅助胸腔镜手术（VATS）治疗SPN的经验。
2015年7月至2016年7月，25例连续的直径小于2 cm的SPN患者在杂交手术室接受了机器人C臂CT引导下的蓝色染料纹身，随后立即行VATS。对他们的病历进行回顾性分析，以评估这一新技术的可行性和安全性。
23例患者（92%）成功进行了机器人C臂CT引导下的染料定位。其余2例患者需要扩大伤口以识别结节。结节的中位大小为1.0 cm（范围0.6 - 2.0 cm）。中位针定位时间和手术时间分别为46分钟和109分钟。所有25例患者均成功切除病变。病理诊断为原发性肺腺癌18例（72%），良性肿瘤5例（20%），转移瘤2例（8%）。无手术死亡病例。术后中位住院时间为3天（范围2 - 8天）。2例患者（8%）出现并发症。1例患者在针定位过程中发生膈肌穿透伤。另1例患者术后发生肺炎。2例患者均经保守治疗。
我们的经验表明，在杂交手术室中采用机器人C臂CT引导下染料定位并立即行胸腔镜手术是安全可行的。它可能成为治疗SPN的一种有效且有吸引力的选择。
