Fernandez Rafael A S, Yu Peter S Y, Chan Joyce W Y, Lim Kevin, Lau Rainbow W H, Ng Calvin S H
Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
AME Case Rep. 2020 Jan 20;4:5. doi: 10.21037/acr.2019.12.04. eCollection 2020.
We describe a case of a 63-year-old lady with an incidental small right upper lobe ground glass opacity (GGO) lesion, who had history of open-heart surgery with bypass grafts for coronary artery disease. Video-assisted thoracic surgery (VATS) excisional biopsy with pre-operative localization was planned. Localization by percutaneous approach is challenging due to position of GGO shielded by both the scapular and ribs. Electromagnetic navigation accuracy may be affected by steel sternal wires but its effect has not been reported on literature. Both virtual and electromagnetic navigation bronchoscopy platforms were used with real-time cone-beam CT confirmation in the hybrid operating room to perform dye marking. Both navigation methods successfully marked the GGO for lung resection. Our case demonstrated that the accuracy of electromagnetic navigation in the presence of steel sternal wire is satisfactory for dye marking and the use of intra-operative cone-beam CT in hybrid operating room is invaluable for the success of navigational bronchoscopy.
我们描述了一例63岁女性患者，其右上叶偶然发现一个小的磨玻璃密度影（GGO）病变，该患者有因冠状动脉疾病接受心脏搭桥手术的病史。计划进行术前定位的电视辅助胸腔镜手术（VATS）切除活检。由于GGO的位置被肩胛骨和肋骨遮挡，经皮定位具有挑战性。电磁导航的准确性可能会受到胸骨钢丝的影响，但文献中尚未报道其影响。在杂交手术室中，同时使用了虚拟和电磁导航支气管镜平台，并通过实时锥形束CT进行确认，以进行染料标记。两种导航方法均成功地对GGO进行了标记，以便进行肺切除。我们的病例表明，在存在胸骨钢丝的情况下，电磁导航用于染料标记的准确性令人满意，并且在杂交手术室中使用术中锥形束CT对于导航支气管镜检查的成功至关重要。
