Anayama Takashi, Yamamoto Marino, Hirohashi Kentaro, Miyazaki Ryohei, Okada Hironobu, Doi Akinori, Orihashi Kazumasa
Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kochi, Japan.
Department of Photodynamic Therapy, Kochi Medical School Hospital, Kochi University, Kochi, Japan.
Quant Imaging Med Surg. 2021 Feb;11(2):725-736. doi: 10.21037/qims-20-781.
For the minimally invasive excision of small-sized pulmonary nodules, bronchoscopic markings are increasingly being performed owing to advancements in video-assisted thoracic surgery (VATS). Hybrid operating room equipment is utilized for bronchoscopic VATS markings. We aimed to compare the marking accuracy between bronchoscopic VATS and other marking techniques such as computed tomography-guided percutaneous marking and conventional X-ray fluoroscopy-guided bronchoscopic marking.
Patients with small-sized pulmonary nodules scheduled to undergo VATS were enrolled in the study. A mixture of 50 to 100 µL of diluted indocyanine green and iopamidol was injected adjacent to the pulmonary nodules as a VATS marker. Patients receiving each of the three image-guided techniques were categorized into group A (computed tomography-guided percutaneous injection), group B (X-ray fluoroscopy-guided virtual bronchoscopy-assisted bronchoscope injection), and group C (cone-beam computed tomography and augmented fluoroscopy-guided virtual bronchoscope-assisted bronchoscopic injection in the hybrid operating room). VATS marking accuracy and procedural complications were compared among the three groups.
In total, 61 patients with 73 pulmonary nodules were eligible for analysis. VATS marking was successful for 15/16 nodules in group A, 28/30 nodules in group B, and 25/27 nodules in group C. Marking accuracy was 5.75±4.59, 15.00±14.02, and 6.05±6.11 (mm), respectively. Multiple markings were successful in 0/1 (0%), 5/6 (83.3%), and 5/5 (100.0%) nodules in groups A, B, and C, respectively. A small pneumothorax occurred in 3/15 (20.0%) patients in group A.
The cone-beam computed tomography and augmented fluoroscopy-guided bronchoscopic approach performed in a hybrid operating room is accurate and equivalent to the computed tomography-guided percutaneous approach, and it enables the VATS marking of multiple pulmonary nodules without causing a secondary pneumothorax.
对于小型肺结节的微创切除，由于电视辅助胸腔镜手术（VATS）的进展，越来越多地进行支气管镜标记。混合手术室设备用于支气管镜VATS标记。我们旨在比较支气管镜VATS与其他标记技术（如计算机断层扫描引导的经皮标记和传统X线透视引导的支气管镜标记）之间的标记准确性。
纳入计划接受VATS的小型肺结节患者。将50至100μL稀释的吲哚菁绿和碘帕醇混合液注射到肺结节附近作为VATS标记。接受三种图像引导技术中的每一种的患者被分为A组（计算机断层扫描引导的经皮注射）、B组（X线透视引导的虚拟支气管镜辅助支气管镜注射）和C组（混合手术室中锥形束计算机断层扫描和增强透视引导的虚拟支气管镜辅助支气管镜注射）。比较三组的VATS标记准确性和手术并发症。
共有61例患者的73个肺结节符合分析条件。A组16个结节中有15个、B组30个结节中有28个、C组27个结节中有25个VATS标记成功。标记准确性分别为5.75±4.59、15.00±14.02和6.05±6.11（mm）。A组、B组和C组分别有0/1（0%）、5/6（83.3%）和5/5（100.0%）的结节多次标记成功。A组3/15（20.0%）的患者发生了小气胸。
在混合手术室中进行的锥形束计算机断层扫描和增强透视引导的支气管镜方法准确，与计算机断层扫描引导的经皮方法相当，并且能够对多个肺结节进行VATS标记而不引起继发性气胸。
