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International Society For Minimally Invasive Cardiothoracic Surgery

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Image-guided Localization Of Difficult Pulmonary Nodules In The Hybrid Theatre: Percutaneous Hookwire Vs. Endoscopic Dye-marking
Sze Yuen Peter Yu1, Cheuk Man Chu2, Wing Hung Rainbow Lau2, Yuk Pui Innes Wan2, Chun Ho Simon Yu2, Sze Hang Calvin Ng2
1The Chinese University of Hong Kong, New Territories, Hong Kong, 2The Chinese University of Hong Kong, Hong Kong, Hong Kong

BACKGROUND: Localization of difficult lung nodules during video-assisted thoracic surgery (VATS) can be challenging. Real-time image-guided localization of the target lesions immediately followed by VATS lung resection in the hybrid operating theatre is an emerging approach. METHODS: We retrospectively reviewed our 5-year experience with image-guided VATS (iVATS) for lung nodules 1.5 cm or less, deep from the lung surface, or soft in consistency. These nodules were localized inside the hybrid operating theatre by either percutaneous hookwire or electromagnetic navigation bronchoscopy (ENB)-guided dye-marking before VATS. RESULTS: From February 2014 to December 2019, lung nodules of indeterminate nature (Mean size: 8.4 3.9 mm; Soft/GGO lesion: 59.6%; Depth-to-diameter ratio: 1.2 1.3) in 57 consecutive patients underwent iVATS. All were accurately localized and resected. There was no perioperative mortality. There were 41 (72%) malignant lesions, all of which were accurately localized by either method with adequate resection margin. Percutaneous hookwire (N = 44, 77%), compared with ENB Dye-Marking (N = 13, 23%), was associated with similar total radiation exposure (14319.3 10662.4 vs. 15766.2 5616.4 uGym2, p = 0.695) and shorter localization time (47.6 27.6 vs. 105.9 29.8 minutes, p < 0.001), but more on-table cone beam computed tomography scan (7.9 2.7 vs. 3.9 1.2 times, p < 0.001), and higher incidence of pneumothorax (55% vs. 0, p < 0.001). CONCLUSIONS: Real-time image-guided localization by either percutaneous hookwire or ENB dye-marking in the hybrid theatre setting are effective facilitators of VATS resection of difficult lung nodules.


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