Bawaadam Hasnain, Benn Bryan S, Colwell Elizabeth M, Oka Tomomi, Krishna Ganesh
Department of Pulmonary and Critical Care Medicine, Aurora Medical Center Kenosha, Kenosha, Wisconsin.
Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
Ann Thorac Surg Short Rep. 2023 Feb 27;1(2):221-225. doi: 10.1016/j.atssr.2023.02.010. eCollection 2023 Jun.
Whereas diagnosis and treatment of pulmonary nodules may be combined during a surgical resection, this approach may lead to excision of benign lesions and excessive healthy lung tissue if the lesion is difficult to localize. Bronchoscopy-guided marking of pulmonary nodules before surgery may facilitate this process, but it is limited by current technologies and often challenging as dye marking may dissipate if surgery is performed days later. We present a novel method to address this problem that allows surgery multiple days after lesion marking with accurate localization.
Four patients with newly identified lung nodules underwent robot-assisted navigation bronchoscopy with lesion marking with a fiducial coil saturated for 10 minutes with indocyanine green (ICG) dye and subsequent thoracic surgery.
The novel approach to soaking the fiducial in ICG allowed the lesions to be seen multiple days (0-9 days) later at the time of da Vinci robotic surgery with the Firefly fluorescence imaging system. No evidence of dye dispersion was visualized, and all surgeries were completed without complications.
Methods to improve peripheral pulmonary nodule marking to facilitate surgical resection are imperative as more asymptomatic, smaller lesions continue to be identified. In our initial experience, placement of ICG dye-soaked fiducial coils for lung nodule marking multiple days before thoracic surgery appears to be a viable option to facilitate surgical resection.
虽然肺结节的诊断和治疗可在手术切除过程中同时进行，但如果病变难以定位，这种方法可能导致良性病变被切除以及过多健康肺组织被切除。术前支气管镜引导下对肺结节进行标记可能有助于这一过程，但受当前技术限制，且如果几天后进行手术，染料标记可能会消散，这通常具有挑战性。我们提出一种新方法来解决这个问题，该方法允许在病变标记数天后进行手术，并能实现精确的定位。
4例新发现肺结节的患者接受了机器人辅助导航支气管镜检查，用吲哚菁绿（ICG）染料使基准线圈饱和10分钟进行病变标记，随后进行胸外科手术。
将基准线圈浸泡在ICG中的新方法使得在达芬奇机器人手术时，通过萤火虫荧光成像系统能够在数天（0 - 9天）后看到病变。未观察到染料弥散的迹象，所有手术均顺利完成，无并发症。
随着越来越多无症状的小病变被发现，改进外周肺结节标记以促进手术切除的方法势在必行。根据我们的初步经验，在胸外科手术前数天将浸泡ICG染料的基准线圈用于肺结节标记似乎是促进手术切除的一个可行选择。
