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Zhang ZS, Wu Y, Zheng B. A Review of Cognitive Support Systems in the Operating Room. Surg Innov 2024; 31:111-122. [PMID: 38050944 PMCID: PMC10773165 DOI: 10.1177/15533506231218962] [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] [Indexed: 12/07/2023]
Abstract
BACKGROUND In recent years, numerous innovative yet challenging surgeries, such as minimally invasive procedures, have introduced an overwhelming amount of new technologies, increasing the cognitive load for surgeons and potentially diluting their attention. Cognitive support technologies (CSTs) have been in development to reduce surgeons' cognitive load and minimize errors. Despite its huge demands, it still lacks a systematic review. METHODS Literature was searched up until May 21st, 2021. Pubmed, Web of Science, and IEEExplore. Studies that aimed at reducing the cognitive load of surgeons were included. Additionally, studies that contained an experimental trial with real patients and real surgeons were prioritized, although phantom and animal studies were also included. Major outcomes that were assessed included surgical error, anatomical localization accuracy, total procedural time, and patient outcome. RESULTS A total of 37 studies were included. Overall, the implementation of CSTs had better surgical performance than the traditional methods. Most studies reported decreased error rate and increased efficiency. In terms of accuracy, most CSTs had over 90% accuracy in identifying anatomical markers with an error margin below 5 mm. Most studies reported a decrease in surgical time, although some were statistically insignificant. DISCUSSION CSTs have been shown to reduce the mental workload of surgeons. However, the limited ergonomic design of current CSTs has hindered their widespread use in the clinical setting. Overall, more clinical data on actual patients is needed to provide concrete evidence before the ubiquitous implementation of CSTs.
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Affiliation(s)
- Zhong Shi Zhang
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Yun Wu
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Bin Zheng
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Antunes MDS, Hochhegger B, Alves GRT, Gazzoni FF, Forte GC, Andrade RGF, Felicetti JC. Postoperative computed tomography of insufflated lung specimens obtained by video-assisted thoracic surgery: detection and margin assessment of pulmonary nodules. Radiol Bras 2022; 55:151-155. [PMID: 35795601 PMCID: PMC9254709 DOI: 10.1590/0100-3984.2021.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/18/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the utility of computed tomography (CT) scans to detect and
assess the margin status of pulmonary nodules that were insufflated after
being resected by video-assisted thoracic surgery. Materials and Methods This was a novel multicenter study conducted at two national referral centers
for thoracic diseases. Patients suspected of having lung cancer underwent
video-assisted thoracic surgery for the resection of pulmonary nodules,
which were submitted to postoperative CT. Measurements from the CT scans
were compared with the results of the histopathological analysis. Results A total of 37 pulmonary nodules from 37 patients were evaluated. The mean age
of the patients was 65 years (range, 36-84 years), and 27 (73%) were female.
A CT analysis of insufflated specimens identified all 37 nodules, and 33 of
those nodules were found to have tumor-free margins. The histopathological
analysis revealed lung cancer in 30 of the nodules, all with tumor-free
margins, and benign lesions in the seven remaining nodules. Conclusion Postoperative CT of insufflated suspicious lung lesions provides real-time
detection of pulmonary nodules and satisfactory assessment of tumor margins.
This initial study shows that CT of insufflated lung lesions can be a
valuable tool at centers where intraoperative histopathological analysis is
unavailable.
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Affiliation(s)
| | - Bruno Hochhegger
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
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3
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Computed tomography–guided platinum microcoil lung surgery: A cross-sectional study. J Thorac Cardiovasc Surg 2019; 158:594-600. [DOI: 10.1016/j.jtcvs.2019.03.096] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/04/2019] [Accepted: 03/10/2019] [Indexed: 11/20/2022]
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Kothapalli PR, Wyler von Ballmoos MC, Chinnadurai P, Lumsden AB, Ramchandani MK. Value of the Hybrid Operating Theater for an Integrated Approach to Diagnosis and Treatment of Pulmonary Nodules in 2019. Front Surg 2019; 6:36. [PMID: 31316994 PMCID: PMC6610426 DOI: 10.3389/fsurg.2019.00036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 06/03/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Priya R Kothapalli
- Department of Cardiothoracic Surgery, DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, United States.,Weill Cornell Medicine, New York, NY, United States
| | - Moritz C Wyler von Ballmoos
- Department of Cardiothoracic Surgery, DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, United States.,Weill Cornell Medicine, New York, NY, United States
| | - Ponraj Chinnadurai
- Department of Cardiothoracic Surgery, DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, United States.,Advanced Therapies, Siemens Medical Solutions Inc., Malvern, PA, United States
| | - Alan B Lumsden
- Department of Cardiothoracic Surgery, DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, United States.,Weill Cornell Medicine, New York, NY, United States
| | - Mahesh K Ramchandani
- Department of Cardiothoracic Surgery, DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, United States.,Weill Cornell Medicine, New York, NY, United States
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Torigoe H, Hirano Y, Ando Y, Washio K. Migration of a hookwire used as a video-assisted thoracoscopic surgery marker into the splenic artery. Gen Thorac Cardiovasc Surg 2019; 68:194-198. [PMID: 31115803 DOI: 10.1007/s11748-019-01142-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/14/2019] [Indexed: 11/25/2022]
Abstract
We present a case in which a hookwire that was used as a video-assisted thoracoscopic (VATS) surgery marker migrated into the splenic artery. The patient was a 70-year-old man with an 18-mm ground glass nodule (GGN) in the right S2. As the GGN was not located in the peripheral part of the lung, a percutaneous hookwire was placed as a marker under CT-guided just before the surgery. We performed VATS right S2 segmentectomy to remove the GGN and the marker; however, we could not locate the marker in the specimen. Histopathological examination revealed adenocarcinoma, TisN0M0, stage 0. CT findings after surgery showed that the marker had migrated into the splenic artery. We followed up the patient, and CT examination conducted 1, 3 and 6 months after the surgery showed no further migration and no damage of the splenic artery. We report the complication of percutaneous hookwire migration into a blood vessel.
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Affiliation(s)
- Hidejiro Torigoe
- Department of Thoracic Surgery, Chugoku Central Hospital, 148-13 Kamiiwanari, Miyukicho, Fukuyama, Hiroshima, 720-0001, Japan.
| | - Yutaka Hirano
- Department of Thoracic Surgery, Chugoku Central Hospital, 148-13 Kamiiwanari, Miyukicho, Fukuyama, Hiroshima, 720-0001, Japan
| | - Yoshitomo Ando
- Department of Radiology, Chugoku Central Hospital, Fukuyama, Japan
| | - Kazuhiro Washio
- Department of Thoracic Surgery, Chugoku Central Hospital, 148-13 Kamiiwanari, Miyukicho, Fukuyama, Hiroshima, 720-0001, Japan
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Mun M, Matsuura Y, Nakao M, Ichinose J, Nakagawa K, Okumura S. Noninvasive computed tomography-guided marking technique for peripheral pulmonary nodules. J Thorac Dis 2016; 8:S672-S676. [PMID: 28066668 DOI: 10.21037/jtd.2016.09.45] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Identification of the exact location of small peripheral pulmonary nodules during thoracoscopic wedge resection (TWR) is crucial. We describe a new method of computed tomography (CT)-guided marking without puncturing the visceral pleura (VP) for minimally palpable pulmonary nodules. METHODS Preoperative CT scans were performed 1 day before TWR with the patient in the lateral decubitus position. Under CT guidance, we marked the skin over the pulmonary nodule. During TS, an indwelling catheter was inserted perpendicular to the marked skin surface and put a mark with gentian violet (Pyoktanin blue®, Wako Pure Chemical Industries, Osaka, Japan) onto the VP. We palpated the nodules near the mark(s) and performed TWR. RESULTS Between October 2012 and April 2016, we performed CT-guided marking in 54 patients (24 males and 30 females, median age 65 years). Cases included 39 primary lung cancers, 10 metastatic lung tumors, and 5 benign tumors. The mean diameter of the nodules was 10 mm (range, 3-26 mm), and the mean distance of the nodule from the VP was 4 mm (range, 0-17 mm). The mean time of intraoperative marking was 3.5 min (range, 1-4.5 min). The mean distance from the nodule to the marking point was 7.0 mm (range, 0-30 mm). We were able to identify the location of the nodule using this procedure in 53 patients (98%). Hematoma of the chest wall after marking was observed in one patient. There were no other complications. CONCLUSIONS This marking technique is a simple, economic, and effective procedure to locate small peripheral pulmonary nodules during TWR.
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Affiliation(s)
- Mingyon Mun
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Tokyo, Japan
| | - Yosuke Matsuura
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Tokyo, Japan
| | - Masayuki Nakao
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Tokyo, Japan
| | - Junji Ichinose
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Tokyo, Japan
| | - Ken Nakagawa
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Tokyo, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Tokyo, Japan
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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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Kamiyoshihara M, Ibe T, Kawatani N, Ohsawa F, Yoshikawa R, Shimizu K. A convenient method for identifying a small pulmonary nodule using a dyed swab and geometric mapping. J Thorac Dis 2016; 8:2556-2561. [PMID: 27747009 DOI: 10.21037/jtd.2016.08.62] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Computed tomography (CT)-guided lung needle marking is useful to identify pulmonary nodules. However, certain complications sometimes trigger severe after-effects or death. So, we present a convenient and safe method by which small pulmonary nodules can be identified using a particular dye [2% (w/v) gentian violet]. METHODS A patient is initially placed in the lateral operative position. Under CT guidance, a "magic marker" is used to identify the skin above the pulmonary nodule. During the operation, the chest wall is punctured on that mark using a needle loop retractor (Mini Loop Retractor II). A swab saturated in the dye solution is attached to a silk thread and passed through the loop. The loop and string are subsequently retracted. The dye-stamp is apparent on the lung surface above the nodule after the lung is inflated. If the scapula, any vertebra, or the clavicle compromised access to a nodule, we used our geometric technique to locate that nodule. RESULTS We used this technique to treat 51 lesions of 50 patients presenting from 2013 to 2015. Mean tumor diameter was 7 mm. All lesions were identified via thoracoscopy, all nodules were constrained by ring forceps, and wedge resections were performed using a stapler. All lesions lay very close to the staple markings, as judged by finger or instrument palpation. No complications were encountered. CONCLUSIONS The advantages of our technique are that it is simple and easy, air emboli are not an issue, the skin marking is rapid, safety is assured, and the skin marking does not require hospitalization. Our method is also useful such as following situations; it defines the margins of the cut line upon anatomical segmentectomy, indicates where a skin incision is required, and identifies impalpable nodules, which aids the lung resection but provides frozen sections to the pathologist.
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Affiliation(s)
| | - Takashi Ibe
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Natsuko Kawatani
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Ryohei Yoshikawa
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Kimihiro Shimizu
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
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A Simple and Safe Technique for CT Guided Lung Nodule Marking prior to Video Assisted Thoracoscopic Surgical Resection Revisited. LUNG CANCER INTERNATIONAL 2015; 2015:235720. [PMID: 26579236 PMCID: PMC4633686 DOI: 10.1155/2015/235720] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 10/12/2015] [Indexed: 11/17/2022]
Abstract
Aim. We describe our experience of a simple, safe, and reproducible technique for lung nodule marking prethoracoscopic metastasectomy. Thoracoscopic lung nodule resection reduces patient discomfort, complications, higher level of care, hospital stay, and cost; however, small deeply placed lung nodules are difficult to locate and resect thoracoscopically. Materials and Methods. We describe and review the success of our novel technique, where nodules are identified on a low dose CT and marked with methylene blue using CT fluoroscopy guidance immediately prior to surgery. Results. 30 nodules were marked with a mean size of 8 mm (4-18 mm) located at a mean depth of 17 mm, distributed through both lungs. Dye was detected at the pleural surface in 97% of the patients and at the nodule in 93%. There were no major complications. Thoracoscopic resection was possible in 90%. Conclusion. This is a simple and safe method of lung nodule marking to facilitate thoracoscopic resection in cases where this may not be technically possible due to nodule location.
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Martínez Criado Y, Pérez Bertólez S, Cabello Laureano R, de Agustín Asensio JC. Instilación de azul de metileno guiado por tomografía axial computarizada para localizar y resecar mediante toracoscopia un nódulo pulmonar. Cir Esp 2014; 92:139-41. [DOI: 10.1016/j.ciresp.2012.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 02/14/2012] [Indexed: 10/27/2022]
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Gobardhan PD, Djamin RS, Romme PJHJ, de Wit PEJ, de Groot HGW, Adriaensen T, Turkenburg JL, Veen EJ. The use of iodine seed (I-125) as a marker for the localisation of lung nodules in minimal invasive pulmonary surgery. Eur J Surg Oncol 2013; 39:945-50. [PMID: 23850089 DOI: 10.1016/j.ejso.2013.06.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 06/20/2013] [Accepted: 06/20/2013] [Indexed: 11/30/2022] Open
Abstract
AIM Video assisted thoracic surgery (VATS) is an important tool in the field of thoracic pathology both for therapeutic and diagnostic purposes. The standard technique for localisation of non-visible or non-palpable lung lesions is the use of image guided insertion of a guide-wire. However, this method is associated with complications such as pneumothorax, bleeding and wire-dislocation. The aim of this study was to investigate the feasibility of using of iodine seeds (I-125) as a marker of lung lesions during VATS. METHODS 28 consecutive patients with parenchymal lung lesions had I-125 seed localisation performed prior to VATS. After seed placement all patients underwent VATS with wedge resection. RESULTS During surgery all lesions could be identified and radically resected. In six (21.4%) patients the seed was not placed optimally but none of these cases were associated with seed dislocation after placement. In four and in 5 patients the placement of the I-125 seed was complicated by a haematoma and pneumothorax respectively. However, in all of these patients a wait-and-see policy would have been justified. In one patient a conversion to a thoracotomy was necessary due to seed displacement. CONCLUSION In patients with parenchymal lung lesions undergoing VATS and wedge resection I-125 seed localisation is a feasible technique. Complication rates are comparable to standard guide-wire localisation. Although I-125 seeds can be positioned under CT-guidance an optimal placement is of utmost importance for VATS wedge resection. Further research is needed to investigate the possible advantages of this technique.
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Affiliation(s)
- P D Gobardhan
- Department of Surgery, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands.
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Lin Y, Liu L, Pu Q. Mini-invasive diagnosis and synchronous treatment of solitary pulmonary nodule. Asian Cardiovasc Thorac Ann 2013; 21:306-12. [PMID: 24570497 DOI: 10.1177/0218492312452268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aim: to develop a simplified method to make a rapid, cost-effective, and precise diagnosis of solitary pulmonary nodules, and to perform synchronous treatment of solitary pulmonary nodules. Methods: the solitary pulmonary nodule was located by digital palpation, and tissue was acquired with a core biopsy gun. In the presence of primary lung cancer, the intervention proceeded to lobectomy. In the case of a benign assessment, the whole nodule was wedged out and sent for a frozen-section double check: if the benign assessment was confirmed, the patient was excluded from further surgery; if the assessment was revised to malignant, the intervention proceeded to lobectomy as well as lymphadenectomy. Results: 76 patients were enrolled. The mean nodule diameter was 1.8 ± 0.6 cm, the mean distance between the visceral pleural and the nodule was 2.4 ± 1.4 cm, and the mean number of punctures was 2.5. The mean time for the phase of intraoperative core biopsy was 10 ± 2 min, and the related blood loss was approximately 5 mL. Fifty-six malignant nodules and 20 benign nodules were confirmed. Both the sensitivity and accuracy were 100%. Conclusion: our results indicate that the simplified mini-invasive diagnosis and treatment is an accurate, safe, rapid, and cost-saving method, which may translate into fundamentally reducing the medical cost and time for lung cancer patients.
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Affiliation(s)
- Yidan Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Kohi MP, Naeger DM, Kukreja J, Fidelman N, Laberge JM, Gordon RL, Kerlan RK. Preoperative CT-Guided percutaneous wire localization of ground glass pulmonary nodules with a modified Kopans wire. J Thorac Dis 2013; 5:E31-4. [PMID: 23585953 DOI: 10.3978/j.issn.2072-1439.2012.07.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 07/01/2012] [Indexed: 11/14/2022]
Abstract
PURPOSE To report a technique of using a modified Kopans wire to localize ground glass pulmonary nodules prior to resection. METHODS CT-guided preoperative localization of ground glass nodules was performed using the modified Kopans wire. RESULTS In both cases, the wire successfully localized the ground glass nodule and the surgeon was able to remove the nodule during video-assisted thoracoscopic wedge resection. CONCLUSIONS Preoperative CT-guided insertion of the modified Kopans wire can result in successful wedge resection of ground glass nodules. The reinforced segment of the modified Kopans wire serves as an excellent source of palpation and localization for the surgeon.
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Affiliation(s)
- Maureen P Kohi
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, 505 Parnassus Ave., M-391, San Francisco, CA 94143-0628, USA
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14
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Kawada M, Okubo T, Poudel S, Suzuki Y, Kawarada Y, Kitashiro S, Okushiba S, Katoh H. A new marking technique for peripheral lung nodules avoiding pleural puncture: the intrathoracic stamping method. Interact Cardiovasc Thorac Surg 2012; 16:381-3. [PMID: 23243032 DOI: 10.1093/icvts/ivs521] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
While performing thoracoscopic wedge resection of the lung, the location of the lesion is generally identified by visual inspection or palpation. When difficulty in identification of the lesion by thoracoscopy is anticipated, preoperative marking is performed. However, complications and technical difficulties plague current marking techniques. To overcome this problem, we designed a new, safe and easy marking technique that avoids pleural puncture, called the intrathoracic stamping method.
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Affiliation(s)
- Masaya Kawada
- Department of General Thoracic Surgery, Tonan Hospital, Sapporo, Japan.
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15
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Belda Sanchis J, Prenafeta Claramunt N, Martínez Somolinos S, Figueroa Almánzar S. [Surgery of lung metastases]. Arch Bronconeumol 2011; 47 Suppl 3:5-8. [PMID: 21640286 DOI: 10.1016/s0300-2896(11)70022-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of surgical treatment of lung metastases is to eliminate all known tumoral disease. After a clinical diagnosis of lung metastases, the criteria for selecting patients who are candidates for surgical treatment, the route of access to the thoracic cavity and the technique for metastases resection are not universally defined. Moreover, half of all patients will show recurrence and the advisability of further surgery will have to be reconsidered. The present article discusses aspects related to the oncological and functional limits of surgical resection of lung metastases, preoperative workup, postoperative follow-up, and the surgical approaches and resection techniques.
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Affiliation(s)
- José Belda Sanchis
- Servicio Mancomunado de Cirugía Torácica, Hospital Universitari Mutua Terrassa, Hospital del Mar de Barcelona, Hospital de la Santa Creu i Sant Pau de Barcelona, España.
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Video-assisted thoracoscopic solitary pulmonary nodule resection after CT-guided hookwire localization: 43 cases report and literature review. Surg Endosc 2010; 25:1723-9. [PMID: 21181200 DOI: 10.1007/s00464-010-1502-3] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 09/03/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Peripheral subpleural solitary pulmonary nodules can be visualized and resected easily at thoracoscopy, but it is very difficult to localize deep nonpalpable pulmonary nodules that lie in lung parenchyma. The purpose of this article was to study the effectiveness of video-assisted thoracoscopic solitary pulmonary nodules resection after computed tomography (CT)-guided hookwire localization and to review the literature related to solitary pulmonary nodule diagnosis and treatment. METHODS From April 2008 to June 2009, 43 patients with a solitary pulmonary nodule who had undergone CT-guided hookwire localization and video-assisted thoracoscopic surgery (VATS) were studied. RESULTS Two cases were considered unsuccessful, other patients underwent CT-guided hookwire localization successfully, and ten patients had an asymptomatic minimal pneumothorax that did not require any intervention. The diameter of nodules ranged from 5 to 30 mm as measured by CT (mean 17.2±7.5 mm). The distance between the center of nodule and visceral pleural ranged from 2 to 40 mm (mean 18.5±9.3 mm). Of the 41 scheduled VATS procedures, 38 patients underwent thoracoscopic wedge resection. Twenty-two of 41 patients who revealed primary lung cancer after frozen-section examination underwent VATS lobectomy and lymphadenectomy. Three patients were converted to thoracotomy, and a major postoperative hemothorax occurred in one patient. No intra- or postoperative mortality or morbidity was recorded. CONCLUSIONS Video-assisted thoracoscopic solitary pulmonary nodule resection after CT-guided hookwire localization is a safe and effective procedure for accurate diagnosis and resection of indeterminate solitary pulmonary nodules.
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