Gómez-Hernández María Teresa, Rivas Duarte Cristina E, Fernández García-Hierro José María, Fuentes Marta G, Colmenares Oscar, Forcada Barreda Clara, Gómez Valle Francisco, Jiménez García Irene, Jiménez Marcelo F
Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain.
Salamanca Institute of Biomedical Research, Salamanca, Spain.
Front Surg. 2024 Sep 30;11:1482120. doi: 10.3389/fsurg.2024.1482120. eCollection 2024.
Intraoperative identification of subsolid or small pulmonary nodules during minimally invasive procedures is challenging. Recent localization techniques show varying success and complications. Hybrid operating rooms (HORs), equipped with radiological tools, facilitate intraoperative imaging. This study compares the accuracy and safety of marking pulmonary nodules using electromagnetic navigation bronchoscopy (ENB) combined with Cone Beam Computed Tomography (CBCT) vs. CBCT-guided percutaneous marking (PM).
This retrospective cohort study included patients with pulmonary nodules scheduled for minimally invasive resection in a HOR. Marking techniques included ENB assisted by CBCT and PM guided by CBCT. The study compared the success rate, procedure time, intraoperative complications and radiation dose of both techniques.
A total of 104 patients with 114 nodules were included (October 2021-July 2024). Thirty nodules were marked using ENB, and 84 with PM. One case used both techniques due to ENB failure. No differences among groups were found in nodule characteristics. Success rates were similar (93.3% in ENB group vs. 91.7% in PM group, = 1). Marking took significantly longer time in the ENB group (median 40 min) compared to PM group (25 min, = 0.007). Five (6%) patients in the PM group experienced intraoperative complications compared to none in the ENB ( = 0.323). Radiation dose was significantly higher in the ENB group ( = 0.002).
ENB assisted by CBCT is a safe and effective technique, with success rates comparable to CBCT-guided PM, though it may result in longer procedural times and higher radiation doses.
在微创手术中对亚实性或小的肺结节进行术中识别具有挑战性。最近的定位技术成功率各异且存在并发症。配备放射学工具的杂交手术室（HORs）有助于术中成像。本研究比较了使用电磁导航支气管镜（ENB）联合锥形束计算机断层扫描（CBCT）标记肺结节与CBCT引导下经皮标记（PM）的准确性和安全性。
这项回顾性队列研究纳入了计划在杂交手术室进行微创切除的肺结节患者。标记技术包括CBCT辅助的ENB和CBCT引导的PM。该研究比较了两种技术的成功率、手术时间、术中并发症和辐射剂量。
共纳入104例患者的114个结节（2021年10月至2024年7月）。使用ENB标记了30个结节，使用PM标记了84个结节。由于ENB失败，有1例使用了两种技术。各亚组间结节特征无差异。成功率相似（ENB组为93.3%，PM组为91.7%，P = 1）。与PM组（25分钟）相比，ENB组标记耗时显著更长（中位数40分钟，P = 0.007）。PM组有5例（6%）患者出现术中并发症，而ENB组无（P = 0.323）。ENB组的辐射剂量显著更高（P = 0.002）。
CBCT辅助的ENB是一种安全有效的技术，成功率与CBCT引导的PM相当，尽管其手术时间可能更长，辐射剂量更高。
