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Real-time augmented fluoroscopy-guided lung marking for thoracoscopic resection of small pulmonary nodules

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Abstract

Background

Small pulmonary nodule localization via an endobronchial route is safe and has fewer complications than that with the transthoracic needle approach, but accurate marking without a navigation system remains challenging. We aimed to evaluate the safety and efficacy of endobronchial dye marking using conventional bronchoscopy guided by cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) for small pulmonary nodules.

Methods

We retrospectively reviewed the clinical records of 61 nodules in 51 patients who underwent preoperative CBCT-AF-guided bronchoscopic dye marking, followed by thoracoscopic resection, between July 2018 and March 2019.

Results

The median nodule size was 8.6 mm [interquartile range (IQR) 7.0–11.8 mm], and the median distance from the pleural space was 15.4 mm (IQR 10.6–23.1 mm). All nodules were identifiable on CBCT images and annotated for AF. The median bronchoscopy duration was 8.0 min (IQR 6.0–11.0 min), and the median fluoroscopy duration was 2.2 min (IQR 1.2–4.0 min). The median radiation exposure (expressed as the dose area product) was 2337.2 µGym2 (IQR 1673.8–4468.8 µGym2). All nodules were successfully marked and resected, and the median duration from localization to surgery was 16.4 h (IQR 4.2–20.7 h). There were no localization-related complications or operative mortality, and the median length of the postoperative stay was 4 days (IQR 3–4 days).

Conclusions

Bronchoscopic dye marking under CBCT-AF guidance before thoracoscopic surgery was safely conducted with satisfactory outcomes in our initial experience.

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Funding

This work was supported by grant from the National Taiwan University Hospital, Hsin-Chu Branch, Taiwan [Grant Number 107-HCH003].

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Authors and Affiliations

  1. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Shun-Mao Yang

  2. Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan

    Shun-Mao Yang & Huan-Jang Ko

  3. Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan

    Kai-Lun Yu

  4. Department of Medical Imaging, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan

    Kun-Hsien Lin, Yueh-Lun Liu & Shao-En Sun

  5. Department of Advanced Therapy, Siemens Healthineers, Taipei, Taiwan

    Ling-Hsuan Meng

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  1. Shun-Mao Yang
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Correspondence to Huan-Jang Ko.

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Disclosures

Ling-Hsuan Meng works for Siemens Company as a medical scientist. Shun-Mao Yang, Kai-Lun Yu, Huan-Jang Ko, Kun-Hsien Lin, Yueh-Lun Liu, and Shao-En Sun have no conflicts of interest or financial ties to disclose.

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Video 1 The entire workflow of augmented fluoroscopy-guided lung marking and thoracoscopic resection. Supplementary material 1 (MP4 337868 kb)

Video 2 Comparison of true target-reaching and false target-reaching. The C-arm fluoroscopy is rotated to confirm that the catheter tip had reached the 3D-annotated target area. 3D, three-dimensional. Supplementary material 2 (MP4 46839 kb)

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Yang, SM., Yu, KL., Lin, KH. et al. Real-time augmented fluoroscopy-guided lung marking for thoracoscopic resection of small pulmonary nodules. Surg Endosc 34, 477–484 (2020). https://doi.org/10.1007/s00464-019-06972-y

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  • DOI: https://doi.org/10.1007/s00464-019-06972-y

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