Single-stage Localization And Thoracoscopic Removal Of Non-palpable Pulmonary Nodules In A Hybrid Operating Room
Federico Mazza, Massimiliano Venturino, Elisa Carla Fontana, Davide Turello, Alberto Gorla, Enrico Peano, Alberto Balderi, Alessandro Locatelli, Giulio Melloni
A.O. Santa Croce e Carle, Cuneo, Italy
BackgroundThe use of hybrid operating room for the simultaneous localization and thoracoscopic removal of pulmonary nodules (iVATS) is gaining popularity. We report our experience with iVATS procedures, with a special attention to our workflow based on the alternative use of two different markers according to the location of the lesion.MethodsAll patients with non-palpable lesions requiring VATS wedge resection underwent localization of the targets in hybrid operating room. Lesions were considered non-palpable if they were small (<1 cm), deep (>1 cm from surface), subsolid or located within a dystrophic area. Anesthetized patients were placed in lateral decubitus. Cone-beam CT was performed, and the needle trajectory was planned by means of dedicated software. A coil was placed in case of lesions deeper than 2 cm or located behind the scapula. In all the remaining situations, a hook-wire was used. The device position was verified by cone-beam CT or fluoroscopy.ResultsFrom April 2016 to November 2019, 39 iVATS were performed. The median lesion size was 9 mm (range 5 - 25). The median distance from the lesion to the pleural surface was 22 mm (range 6 - 37). The localization was performed with 20 hook-wires and 19 coils. iVATS localization was successful in 36 patients (92%). A dislodgment of the hook-wire was observed in 2 patients. In 1 patient the coil was not placed for the onset of a pneumothorax. In all the 3 patients the planned VATS was successfully performed under guidance of the puncture hole on the lung surface. 37 wedge resections were completed by VATS, 2 (5%) required conversion to thoracotomy. In 9 patients with intra-operative diagnosis of lung cancer a lobectomy was performed. Median length of iVATS localization was 24 minutes (range 17-56). Median post-operative length of stay was 4 days (range 2-21).ConclusionsiVATS seems to be a helpful tool for simultaneous localization and removal of non-palpable nodules. A versatile approach using different devices (hook-wire and coil) seems advisable for the removal of targets in every clinical scenario reducing VATS conversion rate. Future research is required to compare iVATS with traditional pre-operative localization techniques.
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