Video-assisted thoracoscopic surgery using mobile computed tomography: New method for locating of small lung nodules

Journal of Cardiothoracic Surgery

Yoshiro Matsui²  Yoshihisa Kotani¹  Naoto Senmaru³  Kichizo Kaga²  Yasuhiro Takahashi³  Kazuto Ohtaka³ 

[1] Department of Orthopedic Surgery, Steel Memorial Muroran Hospital, Muroran, Hokkaido, Japan;Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan;Department of Thoracic Surgery, Steel Memorial Muroran Hospital, Chiribetsu-cho, 050-0076 Muroran, Hokkaido, Japan

关键词: Ground glass nodules;    Video-assisted thoracoscopic surgery;    Lung;    O-arm;   

Others  :  823283
DOI  :  10.1186/1749-8090-9-110

 received in 2014-04-15, accepted in 2014-06-12,  发布年份 2014

【 摘 要 】

Background

The O-arm is an intraoperative imaging device that can provide computed tomography images. Surgery for small lung tumors was performed based on intraoperative computed tomography images obtained using the O-arm. This study evaluated the usefulness of the O-arm in thoracic surgery.

Methods

From July 2013 to November 2013, 10 patients with small lung nodules or ground glass nodules underwent video-assisted thoracoscopic surgery using the O-arm. A needle was placed on the visceral pleura near the nodules. After the lung was re-expanded, intraoperative computed tomography was performed using the O-arm. Then, the positional relationship between the needle marking and the tumor was recognized based on the intraoperative computed tomography images, and lung resection was performed.

Results

In 9 patients, the tumor could be seen on intraoperative computed tomography images using the O-arm. In 1 patient with a ground glass nodule, the lesion could not be seen, but its location could be inferred by comparison between preoperative and intraoperative computed tomography images. In only 1 patient with a ground glass nodule, a pathological complete resection was not performed. There were no complications related to the use of the O-arm.

Conclusions

The O-arm may be an additional tool to facilitate intraoperative localization and surgical resection of non-palpable lung lesions.

【 授权许可】

   
2014 Ohtaka et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

【 参考文献 】

• [1]Sugi K: Radioisotope marking under CT guidance and localization using a handheld gamma probe for small or indistinct pulmonary lesions. Chest 2003, 124:155-1558.
• [2]Lenglinger FX, Schwarz CD, Artmann W: Localization of pulmonary nodules before thoracoscopic surgery: Value of percutaneous staining with methylene blue. AJR 1994, 163:297-300.
• [3]Ciriaco P, Negri G, Puglisi A, Nicoletti R, Maschio AD, Zannini P: Video-assisted thoracoscopic surgery for pulmonary nodules: rationale for preoperative computed tomography-guided hookwire localization. Eur J Cardiothorac Surg 2004, 25:429-433.
• [4]Powell TI, Jangra D, Clifton JC, Lara-Guerra H, Church N, English J, Evans K, Yee J, Coxson H, Mayo JR, Finley RJ: Peripheral lung nodules. Fluoroscopically guided video-assisted thoracoscopic resection after computed tomography-guided localization using platinum microcoils. Ann Surg 2004, 240:481-489.
• [5]Watanabe K, Nomori H, Otsuka T, Kaji M, Naruke T, Suemasu K: Usefulness and complications of computed tomography-guided lipiodol marking for fluoroscopy-assisted thoracoscopic resection of small pulmonary nodules: experience with 174 nodules. J Thorac Cardiovasc Surg 2006, 132:320-324.
• [6]Asano F, Shindoh J, Shigemitsu K, Miya K, Abe T, Horiba M, Ishihara Y: Ultrathin bronchoscopic barium marking with virtual bronchoscopic navigation for fluoroscope-assisted thoracoscopic surgery. Chest 2004, 126:1687-1693.
• [7]Sakiyama S, Kondo K, Matsuoka H, Yoshida M, Miyoshi T, Yoshida S, Monden Y: Fatal air embolism during computed tomography-guided pulmonary marking with a hook-type marker. J Thorac Cardiovasc Surg 2003, 126:1207-1209.
• [8]Santambrogio R: Intraoperative ultrasound during thoracoscopic procedures for solitary pulmonary nodules. Ann Thorac Surg 1999, 68:218-222.
• [9]Sortini A, Carrella G, Sortini D, Pozza E: Single pulmonary nodules: localization with intrathoracoscopic ultrasound. A prospective study. Eur J Cardiothorac Surg 2002, 22:440-442.
• [10]Kawada M, Okubo T, Poudel S, Suzuki Y, Kawarada Y, Kitashiro S, Okushiba S, Katoh H: A new marking technique for peripheral lung nodules avoiding pleural puncture: the intrathoracic stamping method. Interact CardioVasc Thorac Surg 2013, 16:381-383.
• [11]Collins KL, Patil PG: Flat-panel fluoroscopy O-arm-guided percutaneous radiofrequency cordotomy: a new technique for the treatment of unilateral cancer pain. Neurosurgery 2013, 72:27-34.
• [12]Holloway K, Docef A: A quantitative assessment of the accuracy and reliability of O-arm images for deep brain stimulation surgery. Neurosurgery 2013, 72:47-57.
• [13]Costa F, Tomei M, Sassi M, Cardia A, Ortolina A, Servello D, Fornari M: Evaluation of the rate of decompression in anterior cervical corpectomy using an intra-operative computerized tomography scan (O-Arm system). Eur Spine J 2012, 21:359-363.
• [14]Petrov IE, Nikolov HN, Holdsworth DW, Drangova M: Image performance evaluation of a 3D surgical imaging platform. Proc SPIE 2011, 7961:79615O.
• [15]Medtronic Navigation, Inc: O-ARM® 1000 Dosimetry Report, Document Nr: BI-700-00027-041 Rev01. 2008.
• [16]Van de Kelft E, Costa F, Van der Planken D, Schils F: A prospective multicenter registry on the accuracy of pedicle screw placement in the thoracic, lumber, and sacral levels with the use of the O-arm Imaging System and StealthStation Navigation. Spine 2012, 37:E1580-E1587.
• [17]Tabaraee E, Gibson AG, Karahalios DG, Potts EA, Mobasser JP, Burch S: Intraoperative cone beam computed tomography with navigation (O-arm) versus conventional fluoroscopy (C-arm): A cadaveric study comparing accuracy, efficiency, and safety for spinal instrumentation. Spine 2013, 38:1953-1958.