ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
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Cone-beam Ct Guided Localization And Video-assisted Thoracoscopic Resection Of Peripheral Pulmonary Nodules
Mahesh Ramchandani, Min Kim, MD, Puja Gaur, MD, Ponraj Chinnadurai, MB, BS, Alan Lumsden, MD, FRCS.
Houston Methodist, Houston, TX, USA.

Objective:
To illustrate the technique and report preliminary results of C-arm cone-beam CT (CBCT) guided localization and video-assisted minimally invasive thoracoscopic resection (VATS) of small peripheral pulmonary nodules and ground-glass opacities (GGO).
Methods:
A retrospective review of CBCT guided localization followed by VATS done between December 2013 and 2016 was performed. CBCT images were acquired using a robotic C-arm angiography system in a hybrid operating room. Pulmonary nodules or GGOs were targeted under fluoroscopic and laser guidance using breast hook-wire localization needle and coils. Then the procedure was converted to VATS for minimally invasive wedge resection.
Results:
Figure 1 illustrates our technique for CBCT guidance localization and minimally invasive VATS resection. A total of 15 patients underwent CBCT guided localization followed by VATS for small peripheral nodules (n=10) and GGOs (n=5) during the study period. Median (± range) lesion size and distance from pleural surface were 9.85mm (5.1-24.3) and 15.1 mm (0, 47) respectively. In all patients, CBCT imaging identified all the pulmonary lesions diagnosed on pre-operative multi-slice CT imaging. Median number of CBCT (including collimated scans) and radiation dose-area-product (DAP) per scan for lesion localization were 2 scans (1,4) and 1145.1 microGy-m2 per scan. Median time from planning CBCT until lesion localization was 33:46 mins.
Conclusions:
C-arm cone-beam CT image guided localization followed by minimally invasive thoracoscopic resection of peripheral pulmonary nodules and GGOs is technically feasible in a hybrid operating room setup. Current challenges associated with CBCT guided localization include field of view, patient positioning (in obese patients), respiratory motion (in lower-lobe lesions), and additional learning curve for intra-operative 3D imaging.


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