Fluoroscopy-Assisted Thoracoscopic Resection for Small Intrapulmonary Lesions after Preoperative Computed Tomography-Guided Localization Using Fragmented Platinum Microcoils

Moon, Seok Whan; Cho, Deog Gon; Cho, Kyu Do; Kang, Chul Ung; Jo, Min Seop; Park, Hyun Jin

doi:10.1055/s-0031-1299582

Cited by 12 publications

(15 citation statements)

References 16 publications

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“…Similar findings have been recently published for the technique of pre-operative CT-guided microcoil placement and resection with or without intraoperative fluoroscopy (8)(9)(10). Successful use of embolization coils has also been reported in several small series (11)(12)(13), Similar techniques have been described, with pre-operative CT-guided insertion of radiopaque markers attached to sutures that lie on the surface of the lung (14,15), placement of metallic clips (16), fragmented coils (17). One series describes intentional creation of a pneumothorax during the coil placement, by inserted a pigtail catheter to instil air into the pleural space.…”

Section: Discussionmentioning

confidence: 89%

CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature

et al. 2016

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Background: Video-assisted thoracoscopic surgery (VATS) is standard of care for small lung resections at many centres. Computed tomography (CT)-guided insertion of microcoils can aid surgeons in performing VATS resections for non-palpable lung nodules deep to the lung surface.Methods: Retrospective analysis of CT-guided microcoil insertions prior to VATS lung resection at a single institution from October 2008 to January 2014.Results: A total of 63 patients were included (37% male, mean age 61.6±11.4 years). Forty-two patients (67%) had a history of smoking, with 10 current smokers. Sixty one (97%) patients underwent wedge resection and 3 (5%) patients had segmentectomy. Three (5%) patients required intra-operative staple line re-resection for positive or close margins. Eleven (17%) patients had a completion lobectomy, 5 of which were during the same anaesthetic. The average time between the CT-guided insertion and start of operation was 136.6±89.0 min, and average operative time was 84.0±53.3 min. The intra-operative complication rate was 5% (n=3), including 1 episode of hemoptysis, and 2 conversions to thoracotomy. The post-operative complication rate was 8% (5 patients), and included 2 air leaks, 1 hemothorax (drop in hemoglobin), 1 post chest tube removal pneumothorax, and one venous infarction of the lingula after lingula-sparing lobectomy requiring completion lobectomy. . Average post-operative length of stay was 2.2 days. A diagnosis was made for all patients.Conclusions: CT-guided microcoil insertion followed by VATS lobectomy is safe, with short operative times, short length of stay and 100% diagnosis of small pulmonary nodules. This technique will become more important in the future with increasing numbers of small nodules detected on CT as part of lung cancer screening programs.

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Section: Discussionmentioning

confidence: 89%

CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature

et al. 2016

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“…Preoperative image-guided localization can aid in the detection of small nodules and reduce the conversion rate from closed to open thoracotomy [6,7]. Localization methods involve the use of microcoils, hook wires, radioisotopes, and liquid markers such as methylene blue dye, barium, and lipiodol [8][9][10][11][12][13][14]. Fiducial markers are inert, radio-opaque gold seeds that can be visualized with fluoroscopy at the time of resection.…”

mentioning

confidence: 99%

Preoperative Localization of Lung Nodules With Fiducial Markers: Feasibility and Technical Considerations

Sharma

McDermott

Mathisen

et al. 2017

The Annals of Thoracic Surgery

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“…All of these methods have demonstrated beneficial and satisfactory results, but some have shown technical drawbacks. For example, hook-wire has been used with acceptable results from several studies, but failure occurred in 3-20% of patients due to its dislodgement, pneumothorax, bleeding, and air embolism (5). We have also introduced preoperative CT-guided localization using fragmented platinum microcoils and fluoroscopy-assisted thoracoscopic surgery (FATS), which were followed with 6.2% of detecting failures due to displacement of microcoils.…”

Section: Discussionmentioning

confidence: 99%

CT localization for a patient with a ground-glass opacity pulmonary nodule expecting thoracoscopy: a mixture of lipiodol and India ink

Kim¹,

Beck²,

Lee³

et al. 2017

J. Thorac. Dis.

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Small and deeply seated pure ground-glass opacity (GGO) pulmonary nodules (PNs) are not discernible during video-assisted thoracoscopic surgery (VATS). Moreover, pathologists have difficulty in detecting these nodules due to insufficient localization. We percutaneously injected a mixture of lipiodol and India ink during preoperative CT-guided localization in a 52-year-old female patient presenting with a pure GGO PN. A black-pigmented tattoo lesion was clearly identified, and thoracoscopic wedge resection was performed without difficulty. Pathologic results were also discernible, thus allowing the target lesion to be identified without interruption for microscopic analysis. We introduce a novel method using a mixture of lipiodol and India ink with satisfactory results for preoperative localization of GGO PNs prior to VATS.

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Fluoroscopy-Assisted Thoracoscopic Resection for Small Intrapulmonary Lesions after Preoperative Computed Tomography-Guided Localization Using Fragmented Platinum Microcoils

Abstract: CT-guided localization using the fragmented microcoil combined with FATS of small intrapulmonary lesions is a safe, effective, and a diagnostically accurate procedure.

Cited by 12 publications

References 16 publications

CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature

CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature

Preoperative Localization of Lung Nodules With Fiducial Markers: Feasibility and Technical Considerations

CT localization for a patient with a ground-glass opacity pulmonary nodule expecting thoracoscopy: a mixture of lipiodol and India ink

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