9244 Department of Thoracic Surgery, A.O. S. Croce e Carle, Cuneo, Italy.
9244 Department of Radiology, A.O. S. Croce e Carle, Cuneo, Italy.
Innovations (Phila). 2020 Nov/Dec;15(6):555-562. doi: 10.1177/1556984520961039. Epub 2020 Oct 6.
We report our experience with simultaneous localization and thoracoscopic removal for nonpalpable undiagnosed pulmonary nodules.
All patients with nonpalpable lesions requiring video-assisted thoracoscopic surgery (VATS) wedge resection underwent localization of the targets and surgical removal in a hybrid operating room. Lesions were considered nonpalpable if they were small (<1 cm), deep (>1 cm from the surface), subsolid, or located within a dystrophic area. In all cases, intraoperative cone-beam computed tomography was performed for nodule localization and targeting, metal hookwires, or coils were alternatively used for intraoperative marking.
From April 2016 to November 2019, 39 image-guided VATS (iVATS) were performed. The mean lesion size was 12 ± 6 mm. The mean distance from the deep edge of the lesion to the pleural surface was 24 ± 9 mm. The localization was performed with 20 hookwires and 19 coils. iVATS localization was successful in 36 patients (92.3%). Thirty-seven wedge resections were completed by VATS, 2 (5%) required conversion to thoracotomy. In 9 patients with intraoperative diagnosis of lung cancer, a lobectomy was performed (7 VATS and 2 thoracotomies). Mean length of iVATS localization was 30 ± 13 minutes. Median postoperative length of stay was 4 days (IQR 3 to 5).
iVATS seems to be a helpful tool for simultaneous localization and removal of nonpalpable nodules. A versatile approach using different devices seems advisable for the removal of targets in every clinical scenario reducing VATS conversion rate. Future research is required to compare iVATS with traditional preoperative localization techniques.
我们报告同时进行定位和胸腔镜切除无法触及的未确诊肺部结节的经验。
所有需要进行电视辅助胸腔镜手术（VATS）楔形切除术的无法触及病变患者均在杂交手术室中进行目标定位和手术切除。如果病变较小（<1cm）、较深（距表面>1cm）、亚实性或位于营养不良区域，则认为病变无法触及。在所有情况下，均进行术中锥形束 CT 进行结节定位和靶向定位，可交替使用金属钩线或线圈进行术中标记。
从 2016 年 4 月至 2019 年 11 月，共进行了 39 例影像引导下 VATS（iVATS）。病变平均大小为 12±6mm。病变深缘至胸膜表面的平均距离为 24±9mm。采用 20 个钩线和 19 个线圈进行定位。36 例患者（92.3%）iVATS 定位成功。37 例楔形切除术通过 VATS 完成，2 例（5%）需要转为开胸手术。在 9 例术中诊断为肺癌的患者中，行肺叶切除术（7 例 VATS 和 2 例开胸手术）。iVATS 定位的平均时间为 30±13 分钟。术后中位住院时间为 4 天（IQR 3-5）。
iVATS 似乎是同时定位和切除无法触及结节的有用工具。使用不同设备的多功能方法似乎可以减少 VATS 转化率，从而在每种临床情况下都能切除目标。需要进一步的研究来比较 iVATS 与传统术前定位技术。
