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Extended use of the hybrid room for lung nodule localization and minimally invasive resection
Odeaa Al jabbari, MD, Walid K. Abu Saleh, MD, ALAN LUMSDEN, MD, Mahesh Ramchandani, MD.
Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
OBJECTIVE: To report our experience of using intra-operative C-arm Cone beam CT (CBCT) image fusion Guidance along with Video Assisted Thoracoscopic Surgery (VATS) to facilitate localization and removal of a small sub pleural lung nodule - an example of extended use of the hybrid operating room.
METHODS: 3 consecutive patients were operated on. The procedure was performed in the hybrid room, under general anesthesia in thoracotomy position. The Dyna CT was used as a mechanism of fusing a previously acquired CT scan.
A non-contrast rotational CT was performed prior to intervention and image fusion was utilized to fuse the previous obtained CT angiogram. Using the I pilot software in the Syngo system the lung nodules was electronically localized and the approach to the nodule plotted in the reconstruction workspace. This then projects the needle track in the live fluoro system. The needle was then advance to the target and confirming in biplane view that the target has been localized. At that point an embolization coil was placed to ensure that even if the guide wire was displaced we will still be able to localize the nodule fluoroscopically. We used a breast localization needle with a hook to avoid any kind of displacement once the localization was achieved and confirmed the surgery was continue with minithoracotomy. A five cm intercostal incision was made right above where the endoscopic forceps passed. Using a lung clamp to grasp the nodule, firing with an power Endo GIA Stapler were performed and lung was completely resected
RESULTS: Each patient presented with one nodule. The challenge was to assess the feasibility to detect small lesions on a deflated lung during the surgery. We succeeded in locating the nodule in all cases. We didn’t have any significant difficulties to locate the lesion whether it was deep or superficial.
CONCLUSIONS: The intraoperative CBCT is an efficient tool to detect small pulmonary nodule in VATS. It is Associated with augmented reality and offers a significant advance to VATS resection of highly suspicious lung nodules.
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