Intraoperative Thoracic Sonography

Abstract

In contrast to its use in other surgical disciplines, intraoperative sonography has so far been of minor importance in thoracic surgery. The technique of intrathoracic, intraoperative, ultrasonic examination was applied in 85 patients with different indications: in 61 patients during thoracoscopy, in 24 patients during open thoracic surgery. 6 patients eventually underwent a combination of both procedures. In order to improve the intrathoracic maneuverability of the sonographic probe we developed an electrically controllable handle for the probe. The examinations showed a high sensitivity of thoracoscopic ultrasonography for localization of intrapulmonary tumors. In addition, ultrasound was applied to assess the operability of central tumors. The sound frequency available so far for intraoperative application allows a safe distinction of non-infiltrating tumors from vascular structures; the reliable identification of an infiltration mostly requires a higher resolution. If our experiences are confirmed by further application of the method, explorative thoracotomies will surely be partly replaced by explorative thoracoscopic interventions. Ultrasonography has also proved to be useful in visualisation of mediastinal lymph-nodes and tumors, with the possibility of assessing their size.

Ultrasonographic localization of occult pulmonary nodules during video-assisted thoracic surgery

“…As an alternative to hook-wire placement, CT-guided percutaneous staining with methylene blue can be used. Intraoperative sonography is one of the last localization techniques to be introduced, but it soon showed several intraoperative advantages such as its repeatability, the lack of complications and/or morbidity related to the method, its ability to define margins, dimensions and structural characteristics of the lesions and their own adjacent structures and its low cost [4,5,7,10]. Furthermore, it does not cause exposure to ionizing radiation, it can be used for multiple and bilateral lesions and it is able to localize lesions less than 10 mm in diameter which might not be visualized at preoperative exams.…”

“…Friedel et al report 90% of visualized lesions in 42 patients with peripheral coin lesions; 16% of these were not detectable by thoracoscopy or by palpation with grasping forceps [10].…”

Ultrasonography for Localization of Subcentimetre Lung Nodules

“…Extrathoracic ultrasonography can be used successfully in the diagnosis of pleural conditions. It was used under local anesthesia and also in children with VATS [1,[6][7][8][9][10][11][12][13][14]. Ultrasonography was applied to 85 patients with different indications.…”

“…Developed an intrathoracic ultrasonic probe and used it in 61 patients during thoracoscopy and 24 patients during open thoracic surgery. Their study showed that thoracoscopic had high sensitivity for localization of intrapulmonary tumors [1]. Wada and colleagues convex probe ultrasound was used in their study was to assess thoracoscopic localization and biopsy of subcentimetre pulmonary nodules in porcine and rabbit lung models [2].…”

“…The use of ultrasonography for the localization of lung nodules has been reported since in the 1990s [1][2][3][4][5][6][7][8]. Although described in 1990s this technology has not been fully adapted to thoracic surgery.…”