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Li Z, Zhou Z, Feng K, Song X, Xu C, Li C, Zhao J, Ye L, Shen Z, Ding C. Comparison of laser guidance and freehand hook-wire for CT-guided preoperative localization of pulmonary nodules. J Cardiothorac Surg 2024; 19:182. [PMID: 38581004 PMCID: PMC10996078 DOI: 10.1186/s13019-024-02706-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/29/2024] [Indexed: 04/07/2024] Open
Abstract
PURPOSE In VATS surgery, precise preoperative localization is particularly crucial when dealing with small-diameter pulmonary nodules located deep within the lung parenchyma. The purpose of this study was to compare the efficacy and safety of laser guidance and freehand hook-wire for CT-guided preoperative localization of pulmonary nodules. METHODS This retrospective study was conducted on 164 patients who received either laser guidance or freehand hook-wire localization prior to Uni-port VATS from September 1st, 2022 to September 30th, 2023 at The First Affiliated Hospital of Soochow University. Patients were divided into laser guidance group and freehand group based on which technology was used. Preoperative localization data from all patients were compiled. The localization success and complication rates associated with the two groups were compared. The risk factors for common complications were analyzed. RESULTS The average time of the localization duration in the laser guidance group was shorter than the freehand group (p<0.001), and the average CT scan times in the laser guidance group was less than that in the freehand group (p<0.001). The hook-wire was closer to the nodule in the laser guidance group (p<0.001). After the localization of pulmonary nodules, a CT scan showed 14 cases of minor pneumothorax (22.58%) in the laser guidance group and 21 cases (20.59%) in the freehand group, indicating no statistical difference between the two groups (p=0.763). CT scans in the laser guidance group showed pulmonary minor hemorrhage in 8 cases (12.90%) and 6 cases (5.88%) in the freehand group, indicating no statistically significant difference between the two groups (p=0.119). Three patients (4.84%) in the laser guidance group and six patients (5.88%) in the freehand group had hook-wire dislodgement, showing no statistical difference between the two groups (p=0.776). CONCLUSION The laser guidance localization method possessed a greater precision and less localization duration and CT scan times compared to the freehand method. However, laser guidance group and freehand group do not differ in the appearance of complications such as pulmonary hemorrhage, pneumothorax and hook-wire dislodgement.
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Affiliation(s)
- Zijian Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ziyue Zhou
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Kunpeng Feng
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xinyu Song
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chun Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chang Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Li Ye
- Department of Marketing, Neorad Medical Technology (Shanghai) Co., Ltd., Shanghai, 201100, China
| | - Ziqing Shen
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China.
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Cheng Ding
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China.
- Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
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Wang L, He J, Zhang L, Chen C, Chen B, Shen W. A novel preoperative image-guided localization for small pulmonary nodule resection using a claw-suture device. Sci Rep 2023; 13:18950. [PMID: 37919528 PMCID: PMC10622521 DOI: 10.1038/s41598-023-46365-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/31/2023] [Indexed: 11/04/2023] Open
Abstract
Video-assisted thoracoscopic surgery (VATS) provides better option concerning pathological diagnosis and curative intention of small pulmonary nodules (SPNs) that are sometimes challenging to localize. We assess the safety and feasibility of a new localization technique for SPNs, and report experience accumulated over time. A retrospective review of the new claw-suture localization cases between February 2018 and May 2023 was performed. Nodules were localized by a novel system that has an anchor claw and a tri-colored suture, guided by computed tomography (CT). Localization and operative procedure outcomes were then assessed. A total of 590 SPNs were localized from 568 patients before operation. The median nodule size was 0.70 cm (range, 0.3-2.0 cm). The claw-suture localization was successful without dislodgment or device fracture in 574 of 590 lesions (97.3%). Failures included not meeting target distance between claw and lesion (n = 13 [2.2%]), and device displacement (n = 3 [0.5%]). Complications requiring no further medical intervention included asymptomatic pneumothorax (n = 68 [11.5%]), parenchymal hemorrhage (n = 51 [8.6%]), and hemothorax (n = 1 [0.2%]) with the exception of pleural reaction observed in 2 cases (0.3%). Additionally, the depth of pulmonary nodules was significantly associated with the occurrence of pneumothorax (P = 0.036) and parenchymal hemorrhage (P = 0.000). The median duration of the localization was 12 min (range, 7-25 min). No patient complained of remarkable pain during the entire procedure. Retrieve of device after operation was 100%. The new localization technique is a safe, feasible, and well-tolerated method to localize SPNs for VATS resection.
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Affiliation(s)
- Lijie Wang
- Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, 1111 Jiangnan Road, Ningbo, 315040, Zhejiang, China.
| | - Jinxian He
- Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, 1111 Jiangnan Road, Ningbo, 315040, Zhejiang, China
| | - Liang Zhang
- Department of Respiration, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, 315040, Zhejiang, China
| | - Chengcheng Chen
- Department of Radiology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, 315040, Zhejiang, China
| | - Biao Chen
- Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, 1111 Jiangnan Road, Ningbo, 315040, Zhejiang, China
| | - Weiyu Shen
- Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, 1111 Jiangnan Road, Ningbo, 315040, Zhejiang, China
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Alvarez P, Rouzé S, Miga MI, Payan Y, Dillenseger JL, Chabanas M. A hybrid, image-based and biomechanics-based registration approach to markerless intraoperative nodule localization during video-assisted thoracoscopic surgery. Med Image Anal 2021; 69:101983. [PMID: 33588119 DOI: 10.1016/j.media.2021.101983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 01/16/2021] [Accepted: 01/26/2021] [Indexed: 12/09/2022]
Abstract
The resection of small, low-dense or deep lung nodules during video-assisted thoracoscopic surgery (VATS) is surgically challenging. Nodule localization methods in clinical practice typically rely on the preoperative placement of markers, which may lead to clinical complications. We propose a markerless lung nodule localization framework for VATS based on a hybrid method combining intraoperative cone-beam CT (CBCT) imaging, free-form deformation image registration, and a poroelastic lung model with allowance for air evacuation. The difficult problem of estimating intraoperative lung deformations is decomposed into two more tractable sub-problems: (i) estimating the deformation due the change of patient pose from preoperative CT (supine) to intraoperative CBCT (lateral decubitus); and (ii) estimating the pneumothorax deformation, i.e. a collapse of the lung within the thoracic cage. We were able to demonstrate the feasibility of our localization framework with a retrospective validation study on 5 VATS clinical cases. Average initial errors in the range of 22 to 38 mm were reduced to the range of 4 to 14 mm, corresponding to an error correction in the range of 63 to 85%. To our knowledge, this is the first markerless lung deformation compensation method dedicated to VATS and validated on actual clinical data.
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Affiliation(s)
- Pablo Alvarez
- Univ. Rennes 1, Inserm, LTSI - UMR 1099, Rennes F-35000, France; Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble F-38000, France.
| | - Simon Rouzé
- Univ. Rennes 1, Inserm, LTSI - UMR 1099, Rennes F-35000, France; CHU Rennes, Department of Cardio-Thoracic and Vascular Surgery, Rennes F-35000, France.
| | - Michael I Miga
- Vanderbilt Institute for Surgery and Engineering, Vanderbilt University, Nashville, TN, USA.
| | - Yohan Payan
- Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble F-38000, France.
| | | | - Matthieu Chabanas
- Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble F-38000, France; Vanderbilt Institute for Surgery and Engineering, Vanderbilt University, Nashville, TN, USA.
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Zhang H, Li Y, Yimin N, He Z, Chen X. CT-guided hook-wire localization of malignant pulmonary nodules for video assisted thoracoscopic surgery. J Cardiothorac Surg 2020; 15:307. [PMID: 33036640 PMCID: PMC7545541 DOI: 10.1186/s13019-020-01279-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/01/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives Video assisted thoracoscopic surgery (VATS) can currently be used to diagnose and treat pulmonary nodules. However, intraoperative location of pulmonary nodules in VATS is challenging due to their small diameter and deep location in the pulmonary parenchyma. The purpose of this study was to report the clinical safety and effectiveness of CT-guided hook-wire for preoperative localization of malignant pulmonary nodules smaller than 1 cm in diameter. Methods From February 2017 to January 2018, we collected the data of 80 patients with malignant pulmonary nodules less than 1 cm in diameter who underwent CT-guided hook-wire preoperative localization and VATS surgery. The effectiveness of preoperative localization was evaluated based on surgical duration, success rate of VATS surgery, and localization-related complications. Results The diameter of pulmonary nodules were 0.85 ± 0.17 mm with a distance to the pleural surface of 19.66 ± 14.10 mm. The length of the hook-wire in the lung parenchyma was 29.17 ± 13.14 mm and hook-wire dislodgement occurred in 2 patients. Complications included 27 cases of minor pneumothorax and 18 cases of mild parenchymal hemorrhage. A significant correlation was observed between the length of the hook-wire in the lung parenchyma and mild parenchymal hemorrhage (P = 0.044). The average time of hook-wire localization was 9.0 ± 2.6 min and the average operation time for VATS was 89.02 ± 23.35 min without conversion thoracotomy. Conclusions CT-guided hook-wire localization of the lesion during VATS resection is safe for malignant pulmonary nodules with diameter less than 1 cm.
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Affiliation(s)
- Huijun Zhang
- Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, 200040, China.
| | - Ying Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Nadier Yimin
- Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, 200040, China
| | - Zelai He
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China.
| | - Xiaofeng Chen
- Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, 200040, China.
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5
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Sperandeo M, Venuti M, Quarato CMI. Uniportal versus multiportal video-assisted thoracic surgery for lung cancer: safety and advantages in employing complementary intraoperative lung ultrasound. J Thorac Dis 2020; 12:3013-3017. [PMID: 32642222 PMCID: PMC7330758 DOI: 10.21037/jtd.2020.03.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marco Sperandeo
- Unit of Interventional and Diagnostic Ultrasound of Internal Medicine IRCCS Fondazione "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Mariapia Venuti
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy
| | - Carla Maria Irene Quarato
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy
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6
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Londero F, Castriotta L, Grossi W, Masullo G, Morelli A, Tetta C, Livi U, Maessen JG, Gelsomino S. VATS-US1: Thoracoscopic ultrasonography for the identification of nodules during lung metastasectomy. Future Oncol 2020; 16:85-89. [PMID: 31916464 DOI: 10.2217/fon-2019-0608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Open thoracotomy during pulmonary metastasectomy allows lung palpation and may discover unexpected further nodules. We assess the validity of intraoperative lung ultrasonography via thoracoscopy in identifying lung nodules. A first surgeon will perform an ultrasonographic investigation on the deflated lung by thoracoscopy. A second surgeon will then perform a manual exploration of the organ by thoracotomy. Data on number and localization of nodules will be matched and compared with final histology report. Sensitivity and specificity will be assessed. Concordance will be assessed with Cohen K test. Calculated sample size is 89 patients. This study might have an important role in shifting the surgical practice towards a less invasive approach, with consequent benefits for the patient. Protocol is registered on clinicaltrials.gov. Protocol registration number: NCT03864874.
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Affiliation(s)
- Francesco Londero
- Department of Cardiothoracic Surgery, S Maria della Misericordia University Hospital, Udine, Italy
| | - Luigi Castriotta
- Department of Clinical Epidemiology, S Maria della Misericordia University Hospital, Udine, Italy
| | - William Grossi
- Department of Cardiothoracic Surgery, S Maria della Misericordia University Hospital, Udine, Italy
| | - Gianluca Masullo
- Department of Cardiothoracic Surgery, S Maria della Misericordia University Hospital, Udine, Italy
| | - Angelo Morelli
- Department of Cardiothoracic Surgery, S Maria della Misericordia University Hospital, Udine, Italy
| | - Cecilia Tetta
- Radiology Department, Rizzoli Institute, Bologna, Italy
| | - Ugolino Livi
- Department of Cardiothoracic Surgery, S Maria della Misericordia University Hospital, Udine, Italy
| | - Jos G Maessen
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands
| | - Sandro Gelsomino
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands
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Zhang Z, Yang C, Lin J, Hong J, Zhuang Y, Kang M. Effect of closed vacuum aspiration technique on lung collapse time in thoracoscopic anatomical segmentectomy. Medicine (Baltimore) 2019; 98:e15447. [PMID: 31124927 PMCID: PMC6571409 DOI: 10.1097/md.0000000000015447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To investigate the effect of lung expansion and collapse method combined with closed vacuum aspiration technique on lung collapse time, reduce the waiting time of surgery.Forty patients with pulmonary peripheral nodules under thoracoscopic anatomical segmentectomy were divided into 20 cases of natural collapse group and 20 cases of modified collapse group. The natural collapse group used the traditional natural collapse method, and the modified collapse group used a lung expansion and collapse method combined with closed vacuum aspiration technique to record the lung collapse time and compare them.Thoracoscopic anatomical segmentectomy was successfully performed in both groups. The lung collapse time in the natural collapse group and the modified collapse group was 17.08 ± 1.35, 8.90 ± 0.39, respectively, P < .05.The lung expansion and collapse method combined with closed vacuum aspiration technique can reduced the waiting time of lung collapse during thoracoscopic anatomical segmentectomy, and can processed the inter-segment boundary better, thereby reduced the waiting time of surgery.
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Affiliation(s)
- Zhenyang Zhang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital
| | - Chuangcai Yang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital
| | - Jiangbo Lin
- Department of Thoracic Surgery, Fujian Medical University Union Hospital
| | - Junjie Hong
- Department of Thoracic Surgery, Fujian Medical University Union Hospital
| | - Yunyang Zhuang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital
| | - Mingqiang Kang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
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8
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Dailey WA, Frey GT, McKinney JM, Paz-Fumagalli R, Sella DM, Toskich BB, Thomas M. Percutaneous Computed Tomography-Guided Radiotracer-Assisted Localization of Difficult Pulmonary Nodules in Uniportal Video-Assisted Thoracic Surgery. J Laparoendosc Adv Surg Tech A 2018; 28:1451-1457. [PMID: 29979620 DOI: 10.1089/lap.2018.0248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To report our institutional experience with radiotracer-assisted localization of lung nodules (RALN) in combination with uniportal video-assisted thoracoscopic surgery (UVATS). Methods: We retrospectively reviewed electronic medical records and radiology images of 27 consecutive adult patients who underwent planned UVATS lung resections combined with RALN from January 2014 to May 2017. Based on preoperative imaging, 29 nondescript nodules were marked with technetium 99 m macroaggregated albumin under computed tomography guidance before resection. Perioperative outcomes were analyzed. Results: All 29 nodules were successfully marked and resected with negative margins by UVATS; 12 (41.5%) were pure ground-glass opacities. Three patients had prior ipsilateral lung resections. There were no conversions to multiport VATS or thoracotomy. The majority (86.5%) of the nodules were malignant. The median nodule size was 8 mm (range: 3-20 mm) and depth, 56 mm (range: 22-150 mm). The majority (21/27; 77.8%) of patients underwent wedge resections alone, while 6 patients had anatomical resections. Median times were as follows: radiotracer injection to surgery, 219 minutes (range: 139-487 minutes); operative time, 85.5 minutes (32-236 minutes); chest tube removal, 1 day (range: 1-2 days); and length of stay, 2 days (range: 1-4 days). Four patients (14.8%) had a pigtail catheter placed for pneumothorax after radiotracer injection. One patient was readmitted 1 week after discharge for a spontaneous pneumothorax. There were no other morbidities or any 90-day mortality. Conclusion: RALN can be combined with UVATS to effectively resect small, deep, or low-density lung lesions that are difficult to visualize or palpate by thoracoscopy.
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Affiliation(s)
| | - Gregory T Frey
- 2 Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - J Mark McKinney
- 2 Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | | | - David M Sella
- 2 Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Beau B Toskich
- 2 Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Mathew Thomas
- 3 Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
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Thistlethwaite PA, Gower JR, Hernandez M, Zhang Y, Picel AC, Roberts AC. Needle localization of small pulmonary nodules: Lessons learned. J Thorac Cardiovasc Surg 2018; 155:2140-2147. [DOI: 10.1016/j.jtcvs.2018.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 12/14/2017] [Accepted: 01/07/2018] [Indexed: 12/27/2022]
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10
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Moghissi K, Dixon K. Image-guided surgery and therapy for lung cancer: a critical review. Future Oncol 2017; 13:2383-2394. [PMID: 29129114 DOI: 10.2217/fon-2017-0265] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Of the many imaging technologies, some have the potential to be used in image-guided surgery and therapy (IGS/IGT). This review of relevant papers on IGS/IGT for lung cancer indicates effective localization and IGS/IGT in early endobronchial lesions by fluorescence bronchoscopic technique. Visualization of early peripheral (nodular) tumors at operation can be achieved by a variety of imaging methods and devices which allow identification, localization and provision of intraoperative real-time images. Recent developments employing fluorescence contrasts and near infra-red light have shown encouraging feasibility and outcome in providing reliable methods for the IGS of cancer generally and lung cancer more specifically with provision of real time intraoperative imaging. The concept of the hybrid operating theater is touched upon.
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Affiliation(s)
- Keyvan Moghissi
- The Yorkshire Laser Centre, Goole & District Hospital, Woodland Avenue, Goole, East Yorkshire, DN14 6RX, UK
| | - Kate Dixon
- The Yorkshire Laser Centre, Goole & District Hospital, Woodland Avenue, Goole, East Yorkshire, DN14 6RX, UK
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11
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Passera E, Rocco G. From full thoracotomy to uniportal video-assisted thoracic surgery: lessons learned. J Vis Surg 2017; 3:36. [PMID: 29078599 PMCID: PMC5637876 DOI: 10.21037/jovs.2017.01.14] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/10/2016] [Indexed: 11/06/2022]
Abstract
Over the last two decades, conventional video-assisted thoracic surgery (VATS) has established itself as the preferred approach for almost all thoracic surgical procedures. The procedure provides a safe and easy approach with undisputed patient benefit at a cost acceptable to the healthcare system all over the world, in large hospitals as well as underprivileged rural areas. VATS has effectively addressed the patients' right to less scarring, trauma (both of access and intrathoracic manipulation), medication, pain, hospitalization, and early return home and work. These improvements have been further stressed by the introduction of uniportal VATS (uniVATS). Single port surgery is a very exciting new modality in the field of minimal access surgery which aims at further reducing scars of standard vats and towards an hypothetical prospective of scarless surgery.
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Affiliation(s)
- Eliseo Passera
- Department of Thoracic Surgery, Humanitas Gavazzeni Institute, Bergamo, Italy
| | - Gaetano Rocco
- Department of Thoracic Surgery and Oncology, Division of Thoracic Surgery, Istituto Nazionale Tumori, IRCCS, Pascale Foundation, Naples, Italy
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12
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Harris K, Puchalski J, Sterman D. Recent Advances in Bronchoscopic Treatment of Peripheral Lung Cancers. Chest 2017; 151:674-685. [DOI: 10.1016/j.chest.2016.05.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/09/2016] [Accepted: 05/30/2016] [Indexed: 02/04/2023] Open
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13
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Lin MW, Chen JS. Image-guided techniques for localizing pulmonary nodules in thoracoscopic surgery. J Thorac Dis 2016; 8:S749-S755. [PMID: 28066679 DOI: 10.21037/jtd.2016.09.71] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Low-dose computed tomography (LDCT) screening has increased the detection rate for small pulmonary nodules with ground-glass opacity (GGO) in the peripheral lung parenchyma. Minimally invasive thoracoscopic surgery for these lung nodules is challenging for thoracic surgeons, and image-guided preoperative localization is mandatory for their successful resection. Image-guided localization methods primarily include two imaging tools: computed tomography (CT) and bronchoscopy. These different methods may use different localized materials, including hookwires, dyes, microcoils, fiducial markers, contrast media, and radiotracers. Ultrasonography and near-infrared imaging are also used for intraoperative localization of lung lesions. In this article, we review different localization techniques and discuss their indications and limitations.
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Affiliation(s)
- Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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14
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Zhao ZR, Li Z, Situ DR, Ng CSH. Recent clinical innovations in thoracic surgery in Hong Kong. J Thorac Dis 2016; 8:S618-26. [PMID: 27651937 DOI: 10.21037/jtd.2016.03.93] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The concept of personalized medicine, which aims to provide patients with targeted therapies while greatly reducing surgical trauma, is gaining popularity among Asian clinicians. Single port video-assisted thoracic surgery (VATS) has rapidly gained popularity in Hong Kong for major lung resections, despite bringing new challenges such as interference between surgical instruments and insertion of the optical source through a single incision. Novel types of endocutters and thoracoscopes can help reduce the difficulties commonly encountered during single-port VATS. Our region has been the testing ground and has led the development of many of these innovations. Performing VATS, in particular single-port VATS in hybrid operating theatre helps to localise small pulmonary lesions with real-time images, thus increasing surgical accuracy and pushes the boundaries in treating subcentimeter diseases. Such approach may be assisted by use of electromagnetic navigational bronchoscopy in the same setting. In addition, sublobar resection can also be more individualised according to pathologic tumour subtype that require rapid intraoperative diagnostic test to guide appropriate surgical therapy. A focus on technology and innovation for large tumours that require chest wall resection and reconstructions have also been on going, with new materials and prostheses that may be tailored to each individual needs. The current paper reviews the literature pertaining to the above topics and discusses recent related innovations in Hong Kong, highlighting the study results and future perspectives.
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Affiliation(s)
- Ze-Rui Zhao
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zheng Li
- Institute of Digestive Disease, Chow Yuk Ho Technology Centre for Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dong-Rong Situ
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Centre for Cancer Medicine, and Department of Thoracic Surgery, Sun Yat-sen University Cancer Centre, Guangzhou 510060, China
| | - Calvin S H Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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15
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Donahoe LL, Nguyen ET, Chung TB, Kha LC, Cypel M, Darling GE, de Perrot M, Keshavjee S, Pierre AF, Waddell TK, Yasufuku K. CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature. J Thorac Dis 2016; 8:1986-94. [PMID: 27621851 DOI: 10.21037/jtd.2016.06.74] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- Laura L Donahoe
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Elsie T Nguyen
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Tae-Bong Chung
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Lan-Chau Kha
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Marcelo Cypel
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gail E Darling
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Marc de Perrot
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Andrew F Pierre
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Thomas K Waddell
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
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16
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Zhao ZR, Lau RWH, Ng CSH. Hybrid theatre and alternative localization techniques in conventional and single-port video-assisted thoracoscopic surgery. J Thorac Dis 2016; 8:S319-27. [PMID: 27014480 DOI: 10.3978/j.issn.2072-1439.2016.02.27] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Management of pulmonary nodules in terms of diagnosis and intraoperative localization can be challenging, especially in the minimal invasive video-assisted thoracoscopic surgery (VATS) approach, and may be even more difficult with single port VATS with limited access. The ability to localize small lesions intraoperatively is particularly important for excisional biopsy for diagnostic frozen section, as well as to guide sublobar resection. Some of the common techniques to aid localization include preoperative percutaneous hookwire localization, colour dye or radio-dye labelling injection of the nodule or adjacent site to allowing visualization or detection by radioactive counter intraoperatively. The use of hybrid operating room (OR) for intraoperative localization of lung nodules was first reported in 2013, and was called image guided VATS (iVATS). Subsequently, we have expanded the iVATS application for single port VATS major lung resection of small or ground-glass opacity lesions. By performing an on-table cone-beam CT scan, real-time and accurate assessment of the pulmonary lesion can be made, which can aid the localization process. Other types of physical or colour marker that can be deployed percutaneously in the hybrid OR immediate before surgery can enhance haptic feedback and sensitivity of digital palpation, as well as provide a radiopaque nidus for radiological confirmation. In the past decade, the electromagnetic navigation bronchoscopy (ENB) technology had developed into a useful adjunct technology for the localization of peripheral lung nodules by injection of marking agent or deployment of fiducial to the lesion through the endobronchial route causing much lower marking agent diffusion and artefacts. Recently, the combination of hybrid OR and ENB for lung nodule localization and marking has further increased the accuracy and applicability of the technology. The article will be exploring the latest development of the above approaches to lung nodule localization, and discuss some of the techniques' advantages and flaws.
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Affiliation(s)
- Ze-Rui Zhao
- 1 Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China ; 2 State Key Laboratory of Oncology in Southern China, Collaborative Innovation Centre for Cancer Medicine, and Department of Thoracic Surgery, Sun Yat-Sen University Cancer Centre, Guangzhou 510060, China
| | - Rainbow W H Lau
- 1 Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China ; 2 State Key Laboratory of Oncology in Southern China, Collaborative Innovation Centre for Cancer Medicine, and Department of Thoracic Surgery, Sun Yat-Sen University Cancer Centre, Guangzhou 510060, China
| | - Calvin S H Ng
- 1 Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China ; 2 State Key Laboratory of Oncology in Southern China, Collaborative Innovation Centre for Cancer Medicine, and Department of Thoracic Surgery, Sun Yat-Sen University Cancer Centre, Guangzhou 510060, China
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17
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Martin-Ucar AE, Socci L. Location techniques of pulmonary lesions during video-assisted thoracic surgery: a perspective. J Vis Surg 2016; 2:36. [PMID: 29078464 DOI: 10.21037/jovs.2016.03.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 11/06/2022]
Affiliation(s)
| | - Laura Socci
- Department of Cardio Thoracic Surgery, Sheffield Teaching Hospitals, Sheffield, UK
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Daddi N, Sagrini E, Lugaresi M, Perrone O, Candoli P, Ragusa M, Puma F, Mattioli S. Ex vivo pulmonary nodule detection with miniaturized ultrasound convex probes. J Surg Res 2015; 202:49-57. [PMID: 27083947 DOI: 10.1016/j.jss.2015.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 10/24/2015] [Accepted: 12/07/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The intraoperative localization of small and deep pulmonary nodules is often difficult during minimally invasive thoracic surgery. We compared the performance of three miniaturized ultrasound (US) convex probes, one of which is currently used for thoracic endoscopic diagnostic procedures, for the detection of lung nodules in an ex vivo lung perfusion model. METHODS Three porcine cardiopulmonary blocks were perfused, preserved at 4°C for 6 h and reconditioned. Lungs were randomly seeded with different patterns of echogenicity target nodules (9 water balls, 10 fat, and 11 muscles; total n = 30). Three micro-convex US probes were assessed in an open setting on the pleural surface: PROBE 1, endobronchial US 5-10 MHz; PROBE 2, laparoscopic 4-13 MHz; PROBE 3, fingertip micro-convex probe 5-10 MHz. US probes were evaluated regarding the number of nodules localized/not localized, the correlation between US and open specimen measurements, and imaging quality. RESULTS For detecting target nodules, the sensitivity was 100% for PROBE 1, 86.6% for PROBE 2, and 78.1% for PROBE 3. A closer correlation between US and open specimen measurements of target diameter (r = 0.87; P = 0.0001) and intrapulmonary depth (r = 0.97; P = 0.0001) was calculated for PROBE 1 than for PROBES 2 and 3. The imaging quality was significantly higher for PROBE 1 than for PROBES 2 and 3 (P < 0.04). CONCLUSIONS US examination with micro-convex probes to detect pulmonary nodules is feasible in an ex vivo lung perfusion model. PROBE 1 achieved the best performance. Clinical research with the endobronchial US micro-convex probe during minimally invasive thoracic surgery is advisable.
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Affiliation(s)
- Niccolò Daddi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Elisabetta Sagrini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; Division of Internal Medicine, University of Bologna, Bologna, Italy; PhD Course in Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Marialuisa Lugaresi
- Division of Thoracic Surgery, Maria Cecilia Hospital-GVM Care and Research, Cotignola, Ravenna, Italy
| | - Ottorino Perrone
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; Division of Internal Medicine, University of Bologna, Bologna, Italy; PhD Course in Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Piero Candoli
- Division of Pneumology, AUSL Ravenna, Area Vasta Romagna, Ravenna, Italy
| | - Mark Ragusa
- Thoracic Surgery Unit, Department of Surgical-Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Francesco Puma
- Thoracic Surgery Unit, Department of Surgical-Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Sandro Mattioli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; PhD Course in Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Division of Thoracic Surgery, Maria Cecilia Hospital-GVM Care and Research, Cotignola, Ravenna, Italy.
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19
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Zhu Q, Xiao H, Xu E, Liao M, Tang Y, Xuan Y, Su K, He Z, Peng X, Zhang Z, Liu Y, Qiao G. From open to single port video-assisted thoracoscopic lobectomy: a stepwise and return progression of the experience from Department of Thoracic Surgery, General Hospital of Guangzhou Military Command of P.L.A. J Thorac Dis 2015; 7:1252-63. [PMID: 26380742 DOI: 10.3978/j.issn.2072-1439.2015.06.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 06/23/2015] [Indexed: 11/14/2022]
Affiliation(s)
- Qihang Zhu
- Department of Thoracic Surgery, General Hospital of Guangzhou Military Command of P.L.A, Guangzhou 510010, China
| | - Haiping Xiao
- Department of Thoracic Surgery, General Hospital of Guangzhou Military Command of P.L.A, Guangzhou 510010, China
| | - Enwu Xu
- Department of Thoracic Surgery, General Hospital of Guangzhou Military Command of P.L.A, Guangzhou 510010, China
| | - Ming Liao
- Department of Thoracic Surgery, General Hospital of Guangzhou Military Command of P.L.A, Guangzhou 510010, China
| | - Yong Tang
- Department of Thoracic Surgery, General Hospital of Guangzhou Military Command of P.L.A, Guangzhou 510010, China
| | - Yiwen Xuan
- Department of Thoracic Surgery, General Hospital of Guangzhou Military Command of P.L.A, Guangzhou 510010, China
| | - Kai Su
- Department of Thoracic Surgery, General Hospital of Guangzhou Military Command of P.L.A, Guangzhou 510010, China
| | - Zhe He
- Department of Thoracic Surgery, General Hospital of Guangzhou Military Command of P.L.A, Guangzhou 510010, China
| | - Xiufan Peng
- Department of Thoracic Surgery, General Hospital of Guangzhou Military Command of P.L.A, Guangzhou 510010, China
| | - Zhuohua Zhang
- Department of Thoracic Surgery, General Hospital of Guangzhou Military Command of P.L.A, Guangzhou 510010, China
| | - Yan Liu
- Department of Thoracic Surgery, General Hospital of Guangzhou Military Command of P.L.A, Guangzhou 510010, China
| | - Guibin Qiao
- Department of Thoracic Surgery, General Hospital of Guangzhou Military Command of P.L.A, Guangzhou 510010, China
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20
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Gonfiotti A, Jaus MO, Barale D, Viggiano D, Battisti N, Macchiarini P. Uniportal Videothoracoscopic Surgery: Our Indications and Limits. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015. [DOI: 10.1177/155698451501000504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Daniel Barale
- European Center of Thoracic Research (CERT), Florence, Italy
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21
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Uniportal Videothoracoscopic Surgery: Our Indications and Limits. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 10:309-13. [DOI: 10.1097/imi.0000000000000199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective We present our experience with uniportal videothoracoscopic surgery (VATS-U), examining its indications, limits, and results. Methods Since January 2009, 66 patients underwent VATS-U for the following indications: pneumothorax (n = 25), lung nodule (n = 15; n = 10 with preoperative radiolocalization), wedge biopsy (n = 15), hyperhidrosis (n = 10), and chest wall schwannoma (n = 1). The conversion rate to conventional video-assisted thoracic surgery (VATS), postoperative pain, complications, residual paraesthesia, and hospitalization were analyzed. Operative time, postoperative pain, and paraesthesia were retrospectively compared with a cohort of 172 cases of conventional multiportal VATS, performed in the same period. Results Conversion to traditional VATS was necessary in two cases (pulmonary nodule, n = 1; pneumothorax, n = 1). The mean pain score was 0.8, the mean operation time was 42 minutes, and 10 patients had postoperative paraesthesia that lasted a mean of 7 days. No postoperative complications were reported, and the mean postoperative hospital stay was 3 days (range, 1–6 days). The comparison between the VATS-U and the standard multiportal VATS group showed in the VATS-U group a lower but not statistically significant pain score and paraesthesia as well as a lower and statistically significant operative time. Conclusions Uniportal videothoracoscopic surgery has a wide range of indications: lung apex resections and pleurodesis for spontaneous pneumothorax treatment; pulmonary nodule assessment with or without preoperative localization; lung biopsy for interstitial diseases; unilateral or bilateral sympathectomy to treat hyperhidrosis; benign chest wall tumor evaluation. The limits of this technique are linked to pleural adhesions or lung nodules in difficult positions. In our experience, VATS-U results in minimal postoperative pain, allowing for fast functional recovery and a consequent short hospital stay; thus, we suggest that VATS-U is a valid alternative to traditional multiportal VATS for indications beyond cosmetic benefits. Prospective randomized trials are necessary to validate the advantages of uniportal VATS.
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22
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Liu CC, Wang BY, Shih CS, Lin WC. Subxyphoid single-incision thoracoscopic pulmonary metastasectomy. Thorac Cancer 2015; 6:230-2. [PMID: 26273365 PMCID: PMC4448495 DOI: 10.1111/1759-7714.12189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 10/07/2014] [Indexed: 11/30/2022] Open
Abstract
Single-incision thoracoscopic surgery has increasingly attracted public interest and been applied in numerous thoracic procedures. However, single-incision thoracoscopic surgery is associated with requiring subsequent procedures, such as intercostal neuralgia. Herein, we extend the single-port technique of pulmonary metastasectomy through a single subxiphoid approach, and report the first two cases of this procedure to date.
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Affiliation(s)
- Chia-Chuan Liu
- Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center Taipei, Taiwan
| | - Bing-Yen Wang
- Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center Taipei, Taiwan ; Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital and Institute of Medicine, Chung Shan Medical University Taichung, Taiwan ; National Yang-Ming University School of Medicine Taipei, Taiwan
| | - Chih-Shiun Shih
- Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center Taipei, Taiwan
| | - Wei-Cheng Lin
- Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University Taipei, Taiwan
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23
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Salati M, Rocco G. The uni-portal video-assisted thoracic surgery: achievements and potentials. J Thorac Dis 2014; 6:S618-22. [PMID: 25379199 DOI: 10.3978/j.issn.2072-1439.2014.10.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 09/04/2014] [Indexed: 11/14/2022]
Abstract
Described for the first time in 2004 for performing minor lung resection, during the following ten years a growing scientific evidence supported the spread and evolution of the uni-portal video-assisted thoracic surgery (VATS). This novel approach, performed using a single thoracic incision, requires a change of perspective in relation to traditional VATS, offering on the other hand a great versatility for numerous surgical procedures. The present work reviews the literature inherent to the uni-portal VATS with the aim of highlighting the principles of this technique, the fields of application, the obtained results and the future perspectives.
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Affiliation(s)
- Michele Salati
- 1 Division of Thoracic Surgery, United Hospitals-Ancona, Ancona, Italy ; 2 Division of Thoracic Surgery, Department of Thoracic Surgery and Oncology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Gaetano Rocco
- 1 Division of Thoracic Surgery, United Hospitals-Ancona, Ancona, Italy ; 2 Division of Thoracic Surgery, Department of Thoracic Surgery and Oncology, National Cancer Institute, Pascale Foundation, Naples, Italy
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24
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Hung MH, Cheng YJ, Chan KC, Han SC, Chen KC, Hsu HH, Chen JS. Nonintubated uniportal thoracoscopic surgery for peripheral lung nodules. Ann Thorac Surg 2014; 98:1998-2003. [PMID: 25443006 DOI: 10.1016/j.athoracsur.2014.07.036] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/16/2014] [Accepted: 07/21/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Uniportal video-assisted thoracoscopic surgery (VATS) has recently been introduced for various thoracic diseases. However, management of peripheral lung nodules by uniportal VATS without tracheal intubation has rarely been attempted. We evaluated the feasibility and safety of nonintubated uniportal VATS for peripheral lung nodules. METHODS From January to March 2014, 32 patients with indeterminate peripheral lung nodules underwent uniportal VATS without tracheal intubation using a combination of intercostal nerve block, intrathoracic vagal block, and target-controlled sedation. Computed tomography-guided dye localization was sometimes used to identify small or ground-glass opacity lesions. RESULTS A definite diagnosis was obtained in all 32 patients. A wedge resection was performed in 31 patients and a lobectomy in 1. Conversion to nonintubated multiport VATS was required in 4 patients (13%), in 3 because of primary lung cancer requiring further resection for adequacy of margins and in 1 because of difficulty in identifying a small nodule. Conversion to intubated 1-lung ventilation was required in 1 patient (3%) because of vigorous mediastinal movement. Operative complications developed in 2 patients who had air leaks for more than 3 days postoperatively. The median durations of postoperative chest tube drainage and hospital stay were 1 and 3 days, respectively. Postoperative neuralgia that required occasional use of analgesics occurred in only 1 patient (3%), and 97% of patients were very satisfied or satisfied with the resulting scars at 1 month. CONCLUSIONS Nonintubated uniportal VATS is technically feasible and safe for selected patients and is a less invasive alternative in managing indeterminate peripheral lung nodules.
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Affiliation(s)
- Ming-Hui Hung
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuang-Cheng Chan
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Su-Chuan Han
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ke-Cheng Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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25
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Ng CS, Rocco G, Wong RH, Lau RW, Yu SC, Yim AP. Uniportal and single-incision video-assisted thoracic surgery: the state of the art. Interact Cardiovasc Thorac Surg 2014; 19:661-6. [DOI: 10.1093/icvts/ivu200] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Hennon MW, Yendamuri S. [Advance in lung cancer surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 16:C5-8. [PMID: 23677002 PMCID: PMC6123567 DOI: 10.3779/j.issn.1009-3419.2013.03.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
近年来微创技术在各期肺癌的检测、诊断和治疗中的应用出现爆发。这些技术的应用提高了手术的风险-收益比,并且使考虑肺癌手术治疗的患者更易接受手术。同时它们为晚期肺癌患者综合治疗的实施提供了便利。该综述总结了代表肺癌胸外科手术前沿的现有外科技术。
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Affiliation(s)
- Mark W Hennon
- Department of Thoracic Surgery, Roswell Park Cancer Institute, State University of New York, Buffalo, NY, USA
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27
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Rocco G. History and indications of uniportal pulmonary wedge resections. J Thorac Dis 2013; 5 Suppl 3:S212-3. [PMID: 24040526 DOI: 10.3978/j.issn.2072-1439.2013.07.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/08/2013] [Indexed: 11/14/2022]
Affiliation(s)
- Gaetano Rocco
- Department of Thoracic Surgery and Oncology, Division of Thoracic Surgery, National Cancer Institute, Pascale Foundation, Italy
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28
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Martin-Ucar AE, Delgado Roel M. Indication for VATS sublobar resections in early lung cancer. J Thorac Dis 2013; 5 Suppl 3:S194-9. [PMID: 24040523 DOI: 10.3978/j.issn.2072-1439.2013.08.41] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 08/10/2013] [Indexed: 11/14/2022]
Abstract
When dealing with early non-small cell lung cancer (NSCLC) sublobar resections still remain part of the surgical armamentarium. In selected patients with lung cancer, the combination of the potential benefits of parenchyma sparing procedures to the limited trauma provided by Video Assisted Thoracic Surgery (VATS) techniques can become very appealing. Two main groups are included: non-anatomical (wedges) and anatomical (segmentectomies) excisions. We describe the techniques, results and potential indications of both of these techniques.
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Affiliation(s)
- Antonio E Martin-Ucar
- Department of Thoracic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
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29
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Ten-Year Experience on 644 Patients Undergoing Single-Port (Uniportal) Video-Assisted Thoracoscopic Surgery. Ann Thorac Surg 2013; 96:434-8. [DOI: 10.1016/j.athoracsur.2013.04.044] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 04/11/2013] [Accepted: 04/15/2013] [Indexed: 11/21/2022]
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30
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Hennon MW, Yendamuri S. Advances in lung cancer surgery. J Carcinog 2012; 11:21. [PMID: 23346014 PMCID: PMC3548435 DOI: 10.4103/1477-3163.105341] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 12/13/2012] [Indexed: 11/09/2022] Open
Abstract
The last few years have witnessed an explosion of the use of minimally invasive techniques for the detection, diagnosis, and treatment of all stages of lung Cancer. The use of these techniques has improved the risk-benefit ratio of surgery and has made it more acceptable to patients considering lung surgery. They have also facilitated the delivery of multi-modality therapy to patients with advanced lung cancer. This review article summarizes current surgical techniques that represent the “cutting edge” of thoracic surgery for lung cancer.
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Affiliation(s)
- Mark W Hennon
- Department of Thoracic Surgery, Roswell Park Cancer Institute, NY, USA ; Department of Surgery, State University of New York, Buffalo, NY, USA
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31
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One-port (uniportal) video-assisted thoracic surgical resections—A clear advance. J Thorac Cardiovasc Surg 2012; 144:S27-31. [PMID: 22743172 DOI: 10.1016/j.jtcvs.2012.06.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 03/23/2012] [Accepted: 06/05/2012] [Indexed: 11/23/2022]
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32
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Kamiyoshihara M, Nagashima T, Igai H. The Indications for Uniportal Video-Assisted Thoracic Surgery. Ann Thorac Surg 2012; 93:1398; author reply 1398-9. [DOI: 10.1016/j.athoracsur.2011.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 11/07/2011] [Accepted: 12/06/2011] [Indexed: 11/24/2022]
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Rocco G. Reply. Ann Thorac Surg 2012. [DOI: 10.1016/j.athoracsur.2012.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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