Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Division of Thoracic Surgery, Department of Surgical Oncology, Marietta Memorial Hospital, Marietta, Ohio.
Ann Thorac Surg. 2019 Nov;108(5):1528-1534. doi: 10.1016/j.athoracsur.2019.04.107. Epub 2019 Jun 21.
Increased use of chest computed tomography and the institution of lung cancer screening have increased the detection of ground-glass and small pulmonary nodules. Intraoperative localization of these lesions via a minimally invasive thoracoscopic approach can be challenging. We present the feasibility of perioperative transthoracic percutaneous nodule localization using a novel electromagnetic navigation platform.
This is a multicenter retrospective analysis of a prospectively collected database of patients who underwent perioperative electromagnetic transthoracic nodule localization before attempted minimally invasive resection between July 2016 and March 2018. Localization was performed using methylene blue or a mixture of methylene blue and the patient's blood (1:1 ratio). Patient, nodule, and procedure characteristics were collected and reported.
Thirty-one nodules were resected from 30 patients. Twenty-nine of 31 nodules (94%) were successfully localized. Minimally invasive resection was successful in 93% of patients (28/30); 7% (2/30) required conversion to thoracotomy. The median nodule size was 13 mm (interquartile range 25%-75%, 9.5-15.5), and the median depth from the surface of the visceral pleura to the nodule was 10 mm (interquartile range 25%-75%, 5.0-15.9). Seventy-one percent (22/31) of nodules were malignant. No complications associated with nodule localization were reported.
The use of intraoperative electromagnetic transthoracic nodule localization before thoracoscopic resection of small and/or difficult to palpate lung nodules is safe and effective, potentially eliminating the need for direct nodule palpation. Use of this technique aids in minimally invasive localization and resection of small, deep, and/or ground-glass lung nodules.
胸部计算机断层扫描的广泛应用以及肺癌筛查的开展增加了磨玻璃和小结节的检出率。通过微创胸腔镜方法对这些病变进行术中定位可能具有挑战性。我们介绍了使用新型电磁导航平台进行围手术期经胸经皮结节定位的可行性。
这是一项回顾性多中心分析，对 2016 年 7 月至 2018 年 3 月期间尝试微创切除前接受围手术期电磁经胸结节定位的患者的前瞻性收集数据库进行分析。使用亚甲蓝或亚甲蓝和患者血液（1:1 比例）混合物进行定位。收集并报告患者、结节和手术特征。
从 30 名患者中切除了 31 个结节。31 个结节中的 29 个（94%）成功定位。93%的患者（28/30）微创切除成功；7%（2/30）需要转为开胸。结节大小中位数为 13mm（四分位距 25%-75%，9.5-15.5），从脏层胸膜表面到结节的中位数深度为 10mm（四分位距 25%-75%，5.0-15.9）。71%（22/31）的结节为恶性。未报告与结节定位相关的并发症。
在胸腔镜切除小而/或难以触诊的肺结节之前，术中使用电磁经胸结节定位是安全有效的，可能无需直接触诊结节。该技术可辅助微创定位和切除小的、深的和/或磨玻璃样肺结节。
