Thoracoscopic localization of intraparenchymal pulmonary nodules using direct intracavitary thoracoscopic ultrasonography prevents conversion of VATS procedures to thoracotomy in selected patients

Khereba, Mohamed; Ferraro, Pasquale; Duranceau, André; Martin, Jocelyne; Goudie, Eric; Thiffault, Vicky; Liberman, Moïshe

doi:10.1016/j.jtcvs.2012.08.034

Cited by 66 publications

(50 citation statements)

References 21 publications

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“…One of the first small series reported in 1996 described successful identification of small pulmonary nodules, with only 7.5 min of extra operative time required yet up to 150 min required from radiology staff to complete the procedure (38). Proponents of this technique hail the lack of procedure-related complications that are often associated with other methods of pre-operative localization (39,40). Despite the success describes by the aforementioned studies, one main drawback to this technique is the need for near-complete deflation of the lung to improve the resolution of the images.…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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

et al. 2016

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“…1 Furthermore, this technique allowed relatively short operating times (74 + 34 min) 1 and was not associated with complications. 1 However, deflation of the lung is mandatory for visualization of the nodule and therefore its use in patients with emphysema is more challenging. 2 Ultrasonography is highly operator dependent.…”

Section: Localization Of Small Pulmonary Nodulesmentioning

confidence: 98%

“…1 In their prospective non-randomized study, Khereba et al found that intra-operative ultrasonography localized an additional 43% (n = 20/46) of nodules that were not identified by palpation or visualization. 1 Furthermore, this technique allowed relatively short operating times (74 + 34 min) 1 and was not associated with complications. 1 However, deflation of the lung is mandatory for visualization of the nodule and therefore its use in patients with emphysema is more challenging.…”

Section: Localization Of Small Pulmonary Nodulesmentioning

confidence: 98%

MDT lung cancer care: Input from the Surgical Oncologist

2015

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Although there have been many advancements in the multidisciplinary management of non-small cell lung cancer (NSCLC), surgery remains the primary modality of choice for resectable lung cancer when the patient is able to tolerate lung resection physiologically. There have been recent advances in surgical diagnosis and treatment of lung cancer. Increasing use of low-dose computed tomography (CT) screening for lung cancer has resulted in increased detection of small peripheral nodules or semi-solid ground glass opacities. Here, we review different modalities of localization techniques that have been used to aid surgical excisional biopsy when needle biopsy has failed to provide tissue diagnosis. We also report on the current debates regarding the use of sublobar resections for Stage I NSCLC as well as the surgical management of locally advanced NSCLC. Finally, we discuss the complex surgical management of T4 NSCLC lung cancers.

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“…However, an invasive technique such as CT-guided hook-wire localization would not be suitable for all cases, as such procedures would be highly risky if the nodule is near the diaphragm, mediastinum or scapula [15][16][17][18][19]. This scenario thereby provides a new opportunity to implement intraoperative ultrasonography as a noninvasive and repeatable localization technique during robotic-assisted pulmonary surgery [20].…”

Section: Introductionmentioning

confidence: 99%

An “alternative finger” in robotic-assisted thoracic surgery: intraoperative ultrasound localization of pulmonary nodules

et al. 2017

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Aim: Robotic-assisted thoracic surgery (RATS) has become a promising treatment for pulmonary neoplasms. During RATS, intraoperative ultrasonography can act as an “alternative finger” to “touch” and locate lesions, especially pulmonary nodules. This study was aimed to investigate the efficacy of intraoperative ultrasonographic localization during da Vinci RATS procedures.Material and methods: Patients with pulmonary nodules were randomly divided into an Experimental Group and Control Group in which nodules were respectively located using intraoperative ultrasonography or by the surgeon’s anatomic knowledge. The success rates and relevant localization factors were compared between the groups and analyzed to conclude the efficacy of intraoperative ultrasonography. Additionally, the intraoperative ultrasonography learning curve was analyzed to evaluate each surgeon’s ability to independently perform intraoperative ultrasonography.Results: Thirty-four patients were included in the study (n = 17/group). Respectively, the Experimental Group and Control Group comprised 41.2% and 58.9% women (p= 0.937), and had average ages of 55.5 and 55.8 years. In the Experimental group, ultrasonographic localization for mixed ground-glass nodules with CT values of -500 to -100 Hounsfield units had an efficacy of 87.5%. By contrast, the localization efficacy in Control Group was 20.0% (p=0.032).A single surgeon without prior experience performed intraoperative ultrasonography in 20 cases, and the latter 10 procedures required significantly less time relative to the former 10 procedures (p=0.000).Conclusions: During RATS, the use of intraoperative ultrasonography as an “alternative finger” to “touch” and findthe accurate location of pulmonary nodules, especially mixed ground-glass nodules, is warranted.

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Thoracoscopic localization of intraparenchymal pulmonary nodules using direct intracavitary thoracoscopic ultrasonography prevents conversion of VATS procedures to thoracotomy in selected patients

Abstract: Intracavitary VATS-US is a real-time, feasible, reliable, and effective method of localization of intraparenchymal pulmonary nodules during selected VATS wedge resection procedures and can decrease the conversion rates to thoracotomy or lobectomy.

Cited by 66 publications

References 21 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

MDT lung cancer care: Input from the Surgical Oncologist

An “alternative finger” in robotic-assisted thoracic surgery: intraoperative ultrasound localization of pulmonary nodules

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