Department of Research, Charles George VA Medical Center, Asheville, NC, USA.
Department of Surgery, Thoracic Surgery, Charles George VA Medical Center, Asheville, NC, USA.
Innovations (Phila). 2024 Mar-Apr;19(2):136-142. doi: 10.1177/15569845241228854. Epub 2024 Feb 14.
As lung cancer screening increases, the detection of small, nonpalpable lung lesions is on the rise. The hybrid operation room (OR), which combines percutaneous or endobronchial fiducial placement with on-table computed tomography (CT) and fluoroscopic guidance, improves localization and facilitates the diagnosis and treatment of smaller, nonpalpable lung nodules with greater accuracy.
In 35 consecutive months, 55 veterans underwent 60 image-guided video-assisted thoracic surgery procedures for lesion resection. Of the cases, 36% were found during lung cancer screening. All patients received their care in the hybrid OR, where cone-beam CT scan technology was used to place an average of 1.6 fiducials percutaneously ( = 55) or via augmented navigational bronchoscopy ( = 5).
A total of 66 lesions were resected. The median lesion size was 8 mm with an interquartile range of 6 to 14. The patients underwent nonanatomical resection with lymph node dissection using radiologic guidance. When indicated, an anatomical resection was subsequently performed. Of 47 total non-small cell lung cancer lesions, 83% were diagnosed at stage IA1 or IA2. The median surgical margin was 15 mm; the margin was usually 1.5 times as wide as the lesion.
The hybrid OR technology gives a 3-dimensional assessment of the small lung lesions, allowing for a tissue-saving resection while achieving good surgical margins. During lung cancer screening, smaller, nonpalpable lung nodules are frequently found. This technology allows resection of subcentimeter lesions, which would otherwise be unresectable at this early stage, possibly improving survival.
随着肺癌筛查的增加，小而不可触及的肺部病变的检出率也在上升。杂交手术室（OR）将经皮或支气管内基准点放置与术中 CT 和透视引导相结合，提高了定位精度，并更准确地诊断和治疗较小、不可触及的肺结节。
在 35 个月的时间里，55 名退伍军人接受了 60 次影像引导下的电视辅助胸腔镜手术（VATS）进行病变切除。其中 36%是在肺癌筛查中发现的。所有患者均在杂交手术室接受治疗，该手术室使用锥形束 CT 扫描技术，平均经皮放置 1.6 个基准点（共 55 个）或经增强导航支气管镜放置 5 个基准点。
共切除了 66 个病变。病变的中位数大小为 8 毫米，四分位间距为 6 至 14 毫米。患者接受了基于影像学引导的非解剖性切除和淋巴结清扫。在有指征时，随后进行解剖性切除。在 47 个非小细胞肺癌病变中，83%被诊断为 IA1 或 IA2 期。中位手术切缘为 15 毫米，切缘通常比病变宽 1.5 倍。
杂交手术室技术对小的肺部病变进行了三维评估，实现了组织保存性切除，同时获得了良好的手术切缘。在肺癌筛查中，经常会发现较小、不可触及的肺结节。这项技术允许切除亚厘米级的病变，否则这些病变在早期阶段是无法切除的，这可能会提高生存率。
