5 Year Single Centre Experience Of Image-guided Video Assisted Thoracic Surgery For Tiny Pulmonary Nodules In The Hybrid Theatre
SZE YUEN PETER YU1, CHEUK MAN CHU2, WING HUNG RAINBOW LAU1, YUK PUI INNES WAN1, MALCOLM JOHN UNDERWOOD1, CHUN HO SIMON YU2, SZE HANG CALVIN NG1.
11Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong, 22Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
BACKGROUND: Localization of tiny and deep-seated lung nodules during video-assisted thoracic surgery (VATS) can be challenging. Real-time image-guided hookwire localization of the target lesions immediately followed by VATS lung resection in the hybrid operating theatre setting is increasingly recognized as an effective approach.
METHODS: We retrospectively reviewed our 5-year experience with this form of hybrid operating theatre image-guided VATS (iVATS) for lung nodules 1.5 cm or less, deep from the lung surface, or soft in consistency. These patients were compared with matched cohort who received standard hookwire localization in the radiology department (sVATS).
RESULTS: From February 2014 to October 2018, lung nodules of indeterminate nature in 40 consecutive patients with mean nodule size 7.9 ± 3.4 mm underwent iVATS. All were accurately localized by hookwire and successfully resected. There was no perioperative mortality. There were 30 (75%) malignant lesions, all of which were accurately localized with adequate resection margins. Major outcomes were compared with a comparable cohort of 8 patients who received sVATS. iVATS groups has significantly shorter ‘at-risk’ period for pneumothorax progression and hookwire dislodgement (42.3 ± 15.6 minutes for iVATS vs. 109.5 ± 57.1 minutes for sVATS, p < 0.001), and a lower risk of hookwire dislodgement (0 for iVATS vs. 25% for sVATS, p = 0.036).
CONCLUSIONS: Real-time image-guided hookwire localization in the hybrid theatre setting facilitates VATS resection of tiny lung nodules in selected patients, and may have additional advantages in terms of safety and accuracy over the conventional method.
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