Castillo-Larios Rocio, Hernandez-Rojas Daniel, Paciotti Breah, Lee-Mateus Alejandra Yu, Pulipaka Priyanka, Fernandez-Bussy Sebastian, Makey Ian A
Department of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic Florida, Jacksonville, FL, USA.
Department of Cardiovascular and Thoracic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.
AME Case Rep. 2022 Apr 25;6:11. doi: 10.21037/acr-21-71. eCollection 2022.
Despite the availability of various modalities to locate small non-palpable pulmonary nodules during minimally invasive thoracoscopic surgery, precise lung nodule resection remains a challenge. Pre-operative localization techniques add additional time, expense, and complication rate. Intra-operative localization methods, such as ultrasound, may be a real-time solution, but challenges remain with visualizing deep parenchyma lesions and operator-dependent use. Many thoracoscopic wedge resections are performed using a combination of pre-operative imaging and intra-operative landmarks. Although usually cost and time-efficient, the problem occurs when a wedge resection is performed, and the nodule is not within the specimen. This case report describes the use of the O-arm Surgical Imaging System, a full-rotation imaging system that provides three-dimensional cone-beam imaging, in an 81-year-old male patient with a solid 8 mm left lower lobe lung nodule. After two unsuccessful wedge resections, we used the O-arm and finally resected the nodule with a negative surgical margin. The O-arm provided instant feedback regarding the nodule status, allowing a standard thoracoscopy room to function as a hybrid operating room without the need to reposition the patient. Rather than convert to a thoracotomy, proceed to a larger resection, or experience a missed nodule, the O-arm proved to be a helpful intra-operative tool to find a missing lung nodule.
尽管在微创胸腔镜手术中有多种方法可用于定位不可触及的小肺结节，但精确的肺结节切除仍然是一项挑战。术前定位技术会增加额外的时间、费用和并发症发生率。术中定位方法，如超声，可能是一种实时解决方案，但在可视化深部实质病变以及依赖操作者使用方面仍存在挑战。许多胸腔镜楔形切除术是结合术前成像和术中标记进行的。虽然通常具有成本效益且节省时间，但当进行楔形切除术后发现结节不在标本内时，问题就出现了。本病例报告描述了在一名81岁男性患者中使用O型臂手术成像系统（一种提供三维锥形束成像的全旋转成像系统），该患者有一个8毫米实性左下叶肺结节。在两次楔形切除失败后，我们使用了O型臂，最终切除了结节，手术切缘阴性。O型臂提供了关于结节状态的即时反馈，使标准的胸腔镜手术室能够充当混合手术室，而无需重新安置患者。O型臂被证明是一种有用的术中工具，可用于找到遗漏的肺结节，而不是转为开胸手术、进行更大范围的切除或遗漏结节。
