Tailored intraoperative localization of non-palpable pulmonary lesions for thoracoscopic wedge resection using hybrid room technology.
Clin Respir J
; 12(4): 1661-1667, 2018 Apr.
Article
en En
| MEDLINE
| ID: mdl-29028153
ABSTRACT
INTRODUCTION:
VATS wedge resection can require conversion to thoracotomy when pulmonary lesions cannot be identified. Hybrid operating rooms (HORs) provide real-time image acquisition capabilities allowing the intraoperative placement of markers to facilitate the removal of non-palpable nodules during VATS.OBJECTIVES:
To present our workflow based on the alternative use of two different markers according to the location of the lung lesion and report our initial results.METHODS:
All consecutive patients with non-palpable lesions requiring VATS wedge resection underwent localization of the targets in HOR. Lesions were considered non-palpable if they were small (<1 cm), deep (>1 cm from surface), subsolid, or located within a dystrophic area. Anesthetized patients were placed in lateral decubitus. Cone-beam CT (CBCT) was performed, and the needle trajectory was planned using Syngo iGuide Needle Guidance. Metal hook-wire or coil was placed, according to our workflow, close to the lesion and their position was verified by CBCT or fluoroscopy.RESULTS:
Eleven VATS wedge resections were performed in 10 patients with 12 non-palpable lesions. The localization was performed with seven hook-wires and four coils in 30 minutes (range 17-56 minutes). The median estimated total effective dose was 11.6 mSv (range 1.9-24.7 mSv). Eleven lesions were removed by VATS, and one deep nodule required a thoracotomy. No complications were observed.CONCLUSIONS:
Our experience confirms that HOR is suitable for simultaneous localization and VATS resection of 'difficult' pulmonary lesions. A versatile approach, using different devices, seems advisable for the removal of targets in every clinical scenario, reducing the VATS conversion rate.Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Quirófanos
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Neumonectomía
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Nódulo Pulmonar Solitario
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Cirugía Torácica Asistida por Video
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Posicionamiento del Paciente
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Pulmón
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Neoplasias Pulmonares
Tipo de estudio:
Guideline
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Observational_studies
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Prognostic_studies
Idioma:
En
Revista:
Clin Respir J
Año:
2018
Tipo del documento:
Article