Intraoperative Transbronchial Metallic Coil Marking Guided by Mobile 3D C-arm for Resection of a Small Peripheral Lung Lesion

Overview

Journal J Thorac Dis

Publisher AME Publishing Company

Specialty Pulmonary Medicine

Date 2024 Dec 16

PMID 39678909

Authors

Hiromitsu Takizawa

Naoki Miyamoto

Naoya Kawakita

Taihei Takeuchi

Shinichi Sakamoto

Hiroyuki Sumitomo

Atsushi Morishita

Hiroaki Toba

Affiliations

Soon will be listed here.

Abstract

Sublober resection of small peripheral lung lesions using video-assisted thoracoscopic surgery may require marking and confirmation using 3D imaging in the interventional radiology suite or in the hybrid operating room (HOR) before surgery is started. We report a novel approach for intraoperative transbronchial metallic coil marking followed by thoracoscopic wedge resection in a conventional operating room under mobile 3D C-arm guidance. Under general anesthesia, an ultrathin video-bronchoscope was inserted into an objective bronchus guided with virtual bronchoscopic navigation, and a coil-feeding microcatheter was introduced through the bronchoscope's channel. After the position of the catheter tip was confirmed with cone-beam computed tomography (CT) images rendered via a mobile 3D C-arm, a metallic coil was subsequently deployed through the catheter as a marker. During surgery, the nodule with the metallic coil was grasped with pulmonary forceps and fully resected with endostaplers under fluoroscopic guidance. This method has advantages because the transbronchial approach carries a lower risk of complications such as pneumothorax and air embolism compared with a percutaneous approach, and the metallic coil provides more accurate, pinpoint localization compared with liquid dye. Mobile 3D C-arm-guided transbronchial metallic coil marking followed by thoracoscopic wedge resection under fluoroscopic guidance is a one-stop solution for intraoperative marking and resection of small peripheral pulmonary lesions in any operating room.

References

Sato M . Precise sublobar lung resection for small pulmonary nodules: localization and beyond. Gen Thorac Cardiovasc Surg. 2019; 68(7):684-691. DOI: 10.1007/s11748-019-01232-1. View

Sakiyama S, Kondo K, Matsuoka H, Yoshida M, Miyoshi T, Yoshida S . Fatal air embolism during computed tomography-guided pulmonary marking with a hook-type marker. J Thorac Cardiovasc Surg. 2003; 126(4):1207-9. DOI: 10.1016/s0022-5223(03)00821-3. View

Altorki N, Wang X, Kozono D, Watt C, Landrenau R, Wigle D . Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer. N Engl J Med. 2023; 388(6):489-498. PMC: 10036605. DOI: 10.1056/NEJMoa2212083. View

Sato M, Kobayashi M, Kojima F, Tanaka F, Yanagiya M, Kosaka S . Effect of virtual-assisted lung mapping in acquisition of surgical margins in sublobar lung resection. J Thorac Cardiovasc Surg. 2018; 156(4):1691-1701.e5. DOI: 10.1016/j.jtcvs.2018.05.122. View

Toba H, Kondo K, Miyoshi T, Kajiura K, Yoshida M, Kawakami Y . Fluoroscopy-assisted thoracoscopic resection after computed tomography-guided bronchoscopic metallic coil marking for small peripheral pulmonary lesions. Eur J Cardiothorac Surg. 2013; 44(2):e126-32. DOI: 10.1093/ejcts/ezt220. View

Chan J, Lau R, Chu C, Ng C . Expanding the scope of electromagnetic navigation bronchoscopy-guided transbronchial biopsy and ablation with mobile 3D C-arm Machine Cios Spin-feasibility and challenges. Transl Lung Cancer Res. 2021; 10(10):4043-4046. PMC: 8577978. DOI: 10.21037/tlcr-21-619. View

Saji H, Okada M, Tsuboi M, Nakajima R, Suzuki K, Aokage K . Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet. 2022; 399(10335):1607-1617. DOI: 10.1016/S0140-6736(21)02333-3. View

Miyoshi T, Kondo K, Takizawa H, Kenzaki K, Fujino H, Sakiyama S . Fluoroscopy-assisted thoracoscopic resection of pulmonary nodules after computed tomography--guided bronchoscopic metallic coil marking. J Thorac Cardiovasc Surg. 2006; 131(3):704-10. DOI: 10.1016/j.jtcvs.2005.09.019. View

Hsieh M, Chou P, Fang H, Wen C, Chao Y . Single-step localization and excision of small pulmonary nodules using a mobile 3D C-arm. Interact Cardiovasc Thorac Surg. 2021; 33(6):885-891. PMC: 8932509. DOI: 10.1093/icvts/ivab182. View

10.

Patel S, Lindenberg M, Rovers M, van Harten W, Ruers T, Poot L . Understanding the Costs of Surgery: A Bottom-Up Cost Analysis of Both a Hybrid Operating Room and Conventional Operating Room. Int J Health Policy Manag. 2020; 11(3):299-307. PMC: 9278478. DOI: 10.34172/ijhpm.2020.119. View

11.

Munoz-Largacha J, Ebright M, Litle V, Fernando H . Electromagnetic navigational bronchoscopy with dye marking for identification of small peripheral lung nodules during minimally invasive surgical resection. J Thorac Dis. 2017; 9(3):802-808. PMC: 5394035. DOI: 10.21037/jtd.2017.03.18. View

12.

Chao Y, Leow O, Wen C, Fang H . Image-guided thoracoscopic lung resection using a dual-marker localization technique in a hybrid operating room. Surg Endosc. 2019; 33(11):3858-3863. DOI: 10.1007/s00464-019-06883-y. View

13.

Mariolo A, Vieira T, Stern J, Perrot L, Caliandro R, Escande R . Electromagnetic navigation bronchoscopy localization of lung nodules for thoracoscopic resection. J Thorac Dis. 2021; 13(7):4371-4377. PMC: 8339756. DOI: 10.21037/jtd-21-223. View

14.

Hohenforst-Schmidt W, Banckwitz R, Zarogoulidis P, Vogl T, Darwiche K, Goldberg E . Radiation Exposure of Patients by Cone Beam CT during Endobronchial Navigation - A Phantom Study. J Cancer. 2014; 5(3):192-202. PMC: 3931267. DOI: 10.7150/jca.8395. View

15.

Anayama T, Hirohashi K, Okada H, Miyazaki R, Kawamoto N, Yamamoto M . Simultaneous cone beam computed tomography-guided bronchoscopic marking and video-assisted thoracoscopic wedge resection in a hybrid operating room. Thorac Cancer. 2019; 10(3):579-582. PMC: 6397919. DOI: 10.1111/1759-7714.12983. View

16.

Lin M, Chen J . Image-guided techniques for localizing pulmonary nodules in thoracoscopic surgery. J Thorac Dis. 2017; 8(Suppl 9):S749-S755. PMC: 5179342. DOI: 10.21037/jtd.2016.09.71. View