Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Advanced Therapy, Siemens Healthineers, Taipei, Taiwan.
Eur J Cardiothorac Surg. 2018 Feb 1;53(2):353-358. doi: 10.1093/ejcts/ezx309.
This case series illustrates the feasibility of single-stage image-guided video-assisted thoracoscopic surgery for simultaneous localization and removal of small solitary pulmonary nodules (SPNs). The procedure was performed in a hybrid operating room using C-arm cone-beam computed tomography equipped with a laser-guided navigation system.
Between October 2016 and January 2017, 12 consecutive patients presenting with SPNs underwent image-guided video-assisted thoracoscopic surgery. The feasibility and safety of the procedure were assessed through a retrospective review of the patients' clinical charts.
The median size of SPNs was 5.5 mm [interquartile range (IQR) 4-6 mm], whereas their median distance from the pleural surface was 11.7 mm (IQR 6-11.3 mm). All of the lesions were visible on intraoperative C-arm cone-beam computed tomography images, and localization was successful in 10 patients; thereafter, complete thoracoscopic resection was successfully performed. The median time required for the localization of SPNs was 45.5 min (IQR 36-60 min), whereas the median radiation exposure (expressed through the skin absorbed dose) was 223.2 mGy (IQR 180.3-321.3 mGy). Lesion localization was unsuccessful in 2 cases because to the development of pneumothorax induced by needle puncture. In such cases, a utility thoracotomy was required for the identification of SPNs. There was no operative mortality, and the median length of postoperative stay was 4 days (IQR 3.8-4 days).
The results of our case series support the feasibility of image-guided video-assisted thoracoscopic surgery for detection and removal of SPNs. Future efforts should be tailored to decrease localization time and minimize radiation exposure.
本病例系列研究旨在展示单阶段影像引导下电视辅助胸腔镜手术用于同时定位和切除孤立性肺小结节（SPN）的可行性。该手术在配备激光导航系统的 C 臂锥形束 CT 机的杂交手术室中进行。
2016 年 10 月至 2017 年 1 月，连续 12 例 SPN 患者接受了影像引导下电视辅助胸腔镜手术。通过回顾性分析患者的临床病历，评估了该手术的可行性和安全性。
SPN 的中位直径为 5.5mm（四分位距 4-6mm），距胸膜表面的中位距离为 11.7mm（四分位距 6-11.3mm）。所有病变均能在术中 C 臂锥形束 CT 图像上显示，10 例患者成功定位后完成了完全胸腔镜切除。SPN 定位的中位时间为 45.5min（四分位距 36-60min），皮肤吸收剂量的中位辐射暴露量为 223.2mGy（四分位距 180.3-321.3mGy）。2 例因针穿刺引起气胸导致定位失败，需要行小切口开胸术以识别 SPN。无手术死亡病例，术后中位住院时间为 4 天（四分位距 3.8-4 天）。
本病例系列研究结果支持影像引导下电视辅助胸腔镜手术用于 SPN 检测和切除的可行性。未来的研究应致力于缩短定位时间和降低辐射暴露量。
