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Minimally-Invasive Sublobar Resection of Tiny Pulmonary Nodules with Real-Time Image Guidance in the Hybrid Theatre
SZE YUEN PETER YU, WING HUNG RAINBOW LAU, FREDDIE G. CAPILI, YUK PUI INNES WAN, MALCOLM JOHN UNDERWOOD, CHEUK MAN CHU, CHUN HO SIMON YU, SZE HANG CALVIN NG.
The Chinese University of Hong Kong, Hong Kong, Hong Kong.

OBJECTIVE: Localization of tiny lung nodules during video-assisted thoracic surgery (VATS) sublobar resection can be challenging. Real-time image-guided hookwire localization of target lesions immediately preceding lung resection in the hybrid operating theatre setting is an emerging approach.
METHODS: We retrospectively reviewed our experience with the real-time image guidance of hookwire insertion for lung nodules 1.5 cm or less using cone-beam computer tomography scan, followed immediately by VATS sublobar resection in the same operating suite and session.
RESULTS: From February 2014 to October 2015, tiny lung nodules of indeterminate nature in 19 consecutive patients with mean nodule size 7.7 ± 3.4 mm, (range 2-15 mm) underwent the procedure. All were localized accurately by hookwire and successfully resected. Five (26.3%) patients developed pneumothorax after hookwire insertion but none required intervention. The mean operative time was 128.5 ± 60.6 minutes, and blood loss 25.5 ± 15.0 mL. The mean chest drain duration was 2.6 ± 0.9 days and postoperative length of stay 3.6 ± 1.7 days. There were no postoperative complications or mortality. There were 14 (73.7%) malignant and 5 benign lesions all with adequate resection margins.
CONCLUSIONS: Real-time image-guided hookwire localization in the hybrid theatre setting is a safe and effective technique for VATS resection of tiny lung nodules. Its potential advantages over the traditional approach warrants further studies.


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