Intraoperative Indirect Localization Of Small GGN With Electromagnetic Navigation Bronchoscopy
Kwanyong Hyun, In Kyu Park, Samina Park, Yoohwa Hwang, Hyun Joo Lee, Chang Hyun Kang, Young Tae Kim.
Seoul National University Hospital, Seoul, Korea, Republic of.
OBJECTIVE: Peripheral pulmonary lesions are being diagnosed with increasing frequency, which makes the role of localization important. Electromagnetic navigation bronchoscopy (ENB) can provide more obvious target for the surgeon to facilitate intraoperative resection when combined with dye-marking.
METHODS: Patients with sub-centimeter peripheral ground glass nodule (GGN) underwent ENB-guided dye marking and minimally invasive resection from July 2016 to September 2016. Indications of ENB-guided dye marking were GGNs ≤ 10 mm adjacent to the visceral pleura or GGNs ≤ 20 mm located more than 10 mm deep from the visceral pleura. Marking was done with 0.5 ml of Indigo Carmine under ENB guide without fluoroscope after induction of general anesthesia.
RESULTS: A total of 9 ENB-guided marking procedures were performed for 7 GGNs. Additional 2 marking was performed to delineate the resection margin. The median nodule size was 14 (4-18) mm and the median distance from the pleural surface was 8.1 (0-22.3) mm. The median navigation time was 12.5 (9.5-40) minutes. Localization was failed in 2 out of 9 markings due to invisible dye. GGNs were resected mostly by thoracoscopic segmentectomy or by wedge resection if indicated, with the right lower lobe (4/7) being the most common site. All GGNs were primary lung cancers and completely resected. There were no complications related with localization procedure such as bleeding or pneumothorax.
CONCLUSIONS: Intraoperative ENB-guided dye marking for GGN is simple and effective method for localization of the nodule and, moreover, estimating the segmental resection margin. More experience about the navigational planning and the concomitant aid of fluoroscope would increase the success rate of localization.
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