Robotic-assisted Bronchoscopy For Identification Of Lung Nodules In Minimally-invasive Thoracic Surgery
James Shahoud, Benny Weksler, Sohini Ghosh, Aarthi Ganesh, Hiran Fernando.
Allegheny General Hospital, Pittsburgh, PA, USA.
BACKGROUND:Small pulmonary nodules can be difficult to identify during a minimally invasive surgical (MIS) resection. Previous investigators have reported using bronchoscopy with electromagnetic navigation to help identify lesions. Robotic-assisted bronchoscopy has recently been introduced into clinical practice and has shown utility in identifying small lesions. We report our early experience using robotic-assisted bronchoscopy (with the ION system) with dye marking to aid in minimally invasive thoracic surgery.
METHODS:Patients with peripheral pulmonary nodules underwent robotic-assisted bronchoscopy before a planned minimally invasive resection, using either robot-assisted or video-assisted thoracic surgery approach. Indocyanine green or methylene blue was injected directly into the targeted lesion. Surgical resection was then performed. Primary success was defined as successful dye localization and sub-lobar resection of the target nodule. Secondary success was defined as successful identification of the lesion without the need for lobectomy or thoracotomy.
RESULTS: Thirty patients with a single targeted nodule underwent robot-assisted bronchoscopy followed by MIS resection. Median lesion size was 9 mm (4-25 mm) and the median distance from the pleura was 5 mm (1-32 mm). Primary success rate was 83.3% (25/30). In three cases the dye was not visualized and in two cases there was free extravasation of dye. Secondary success rate was 100%. Pathology revealed non-small cell lung cancer (n = 13, 43.3%), metastatic disease (n = 11, 36.7%), and benign disease (n = 6, 20%). There were no complications related to the use of robotic-assisted bronchoscopy.
CONCLUSIONS:Robotic-assisted bronchoscopy with dye marking is safe and effective for guiding minimally invasive resection of small peripheral pulmonary nodules.
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