Intraoperative ultrasonographic localization of pulmonary ground-glass opacities

Kondo, Ryoichi; Yoshida, Kazuo; Hamanaka, Kazutoshi; Hashizume, Masahiro; Ushiyama, Toshiki; Hyogotani, Akira; Kurai, Makoto; Kawakami, Satoshi; Fukushima, Mana; Amano, Jun

doi:10.1016/j.jtcvs.2009.02.002

Cited by 97 publications

(79 citation statements)

References 15 publications

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“…As to the issue of segmentectomy, this is certainly a plausible future scenario for uniportal VATS utilization, especially in primary lung cancers. In this setting, the concept of uniportal VATS is currently being adapted to perform lobectomy [4]. In conclusion, I agree with Dr Kamiyoshihara and colleagues that the specific geometric approach and future technological and anesthesiological advancements may further contribute to expand the indications of uniportal VATS in thoracic surgery [5,6].…”

Section: Reply To the Editormentioning

confidence: 84%

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The Indications for Uniportal Video-Assisted Thoracic Surgery

Kamiyoshihara

Nagashima

Igai

2012

The Annals of Thoracic Surgery

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Section: Reply To the Editormentioning

confidence: 84%

“…Consequently, was ultrasonography needed? I think that we really need to identify the ground glass opacity (GGO) [4]. Do the authors plan to cover GGO in the future?…”

mentioning

confidence: 99%

The Indications for Uniportal Video-Assisted Thoracic Surgery

Kamiyoshihara

Nagashima

Igai

2012

The Annals of Thoracic Surgery

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“…Lipiodol injection can also distort frozen section histological specimens, with a possibility for systemic or pulmonary embolization (20). Intraoperative ultrasonography can localize lung nodules even if ground glass opacity (GGO) is present; however, its limitation is that residual air, operators' experience, and chronic obstructive pulmonary disease can make localization difficult (21,22). Despite all the progress of localizing methods, big challenges remain under certain circumstances.…”

Section: Discussionmentioning

confidence: 99%

Remedial localization after dislodgement of primary mechanical localization in lung surgery

Wang

Zhang

et al. 2017

J. Thorac. Dis.

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Background: Unhooking or displacement of hookwire or microcoil due to technical failures is rather common. We aim to establish a new technique for remedial localization in the case of displacement or unhooking of primary mechanical localization during lung surgery. Methods: From February 2014 to September 2015, 18 consecutive cases of intraoperative dislodgement during video-assisted thoracoscopic surgery (VATS) were enrolled. Nodule's projection on body surface was located by analyzing computed tomography (CT) images, and a needle was inserted into thoracic cavity through this point. The lung was then inflated, and a small burn was made where the needle tip touched the visceral plural. Wedge resections were subsequently performed for these impalpable small lesions. Results: Eighteen solitary pulmonary nodules (SPNs) from 18 patients were scheduled for VATS wedge resections in this series, including 6 (33.3%) hookwire localization and 12 (66.7%) microcoil localization.Fifteen (83.3%) of 18 nodules were pure ground glass opacity (pGGO) and 3 (16.7%) mixed ground glass opacity (mGGO). The mean diameter of SPNs was 7.7±3.6 mm. The mean distance from SPN to pleura was 12.2±10.9 mm. During remedial localization, 17 (94.4%) nodules were removed successfully by wedge resection, and segmentectomy was performed only in one case with failed outcome. Paraffin pathology showed 2 (11.1%) atypical adenomatous hyperplasia (AAH), 11 (61.1%) adenocarcinoma in situ (AIS), 4 (22.2%) minimally invasive adenocarcinoma (MIA), and 1 (5.6%) inflammatory disease.Conclusions: This remedial localization technique is practical and reliable. It is a good backup plan in the case of dislodgement, and it can help prevent extended lung resection.

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“…In cases of pure GGO, Kondo identified 53 lesions using ultrasound probe of which only 19 were palpated (14). In this series patients with chronic obstructive pulmonary disease (COPD) were excluded, clearly defining some of the limitations of this technique.…”

Section: Available Methodsmentioning

confidence: 99%

Location techniques of pulmonary lesions during video-assisted thoracic surgery: a perspective

Martin-Ucar

Socci

2016

J. Vis. Surg.

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We read with interest the article by Bertolaccini et al. describing the use of radioactive injections to identify small solitary pulmonary nodules or impalpable ground glass opacities (GGO) during video-assisted thoracic surgery (VATS) surgery (1). The advocates of localization methods for these lesions have described over the years different techniques in thoracic surgery, most of them derived from their uses in other organs and specialties. Available methodsThe use of CT-guided hooks applying a valid concept used in the diagnosis of small breast lesions diagnosis was probably the initial one. Ciriaco et al. (2) described its use in a series of 53 VATS procedures in 2004, and successful identification rates over 95% can be achieved with this method by several authors in series over 50 cases (3)(4)(5). The potential pitfalls of this technique were the potential side effects of pneumothorax and bleeding, but also migration of the wire, when the lung collapses during surgery. It does require collaboration with the Radiology Unit and the patient to be transferred into the operating theatre straight from the Scanner suite. These two areas vary from unit to unit hence the process might not be universally reproducible.To minimize the potential for migration of the wire clinicians developed the insertion of metal coils. The metal coils are no longer attached to the chest wall reducing the potential for migration at lung collapse but also requiring less care to avoid touching or manipulating the wire during Once again the arrangements with the Radiology Unit and the transfer into the operating room are required, but in addition the operating room must be suitable for on the table radiology in order to identify the metal coil.Non-metal markers have been described for identification of lesions during VATS surgery. In 1994 Lenglinger et al. reported the use of methylene blue helping identification in 14 out of 15 patients (7), results mimicked by Vandoni et al. in 2002 in series of 54 patients with a success of 93% (8). The benefit proposed was the safety of avoiding deployment of wires, and not requiring any special radiological equipment in the operating room. However, during VATS the methylene blue mainly directs to the surface point of access and dispersion of the dye might make difficult exact localizations of the lesions.Injection of radiological contrasts did prove 100% successful in 15 and 10 patients respectively by the groups of Choi in 1998 (9) and Lee in 2012 (10). It does however require the availability of radiological equipment in the operating room in order to locate the lesion marked by contrast.A potential advance was adopted from liver surgery, with the ability to identify nodules via ultrasound probe was initially described by Greenfield et al. in 1997 (11)

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Intraoperative ultrasonographic localization of pulmonary ground-glass opacities

Cited by 97 publications

References 15 publications

The Indications for Uniportal Video-Assisted Thoracic Surgery

The Indications for Uniportal Video-Assisted Thoracic Surgery

Remedial localization after dislodgement of primary mechanical localization in lung surgery

Location techniques of pulmonary lesions during video-assisted thoracic surgery: a perspective

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