CT-guided placement of microcoil end in the pleural cavity for video-assisted thoracic surgical resection of ground-glass opacity: a retrospective study

Uniportal video-assisted thoracic surgery resection of subsolid or millimetric nodules using an innovative micro-coil technique: our experience

Background

Sometimes, the identification of ground-glass opacities (GGOs), small or deep pulmonary nodules can be difficult also in expert hands. Usually for these lesions pulmonary lobectomy is an overtreatment, so we developed a technique to identify easily these nodules. The objective of this research is to assess the effectiveness and safety of using preoperative cone beam computed tomography (CBCT) to guide the placement of micro-coils in the lung parenchyma near GGO and small lesions. Additionally, the study aims to identify potential factors that could predict coil-assisted failures during uniportal video-assisted thoracic surgery (U-VATS) resections.

Methods

The clinical, radiological, and surgical records of 117 patients who underwent U-VATS resection following CBCT-guided micro-coil localization of GGOs and small deep nodules between January 2017 and February 2023 were retrospectively analyzed. We have placed a micro coil under CBCT guide before the intervention in the 24 hours preceding the intervention. The patient received a pulmonary wedge resection in U-VATS technique and an immediate fresh frozen section to determine the necessity of a pulmonary lobectomy.

Results

One hundred and eight lesions/117 lesions (92.3%) were correctly identified by the coil. The coil placement had only mild complications: perilesional bleeding, pneumothorax requiring pleural drainage (2/117), hypotension (2/117), subcutaneous emphysema (1/117) and 1 case of coil retained in the chest wall. Ninety-seven lesions/117 lesions (82.9%) were malignant. Among these, 74 (76.3%) were lung adenocarcinomas.

Conclusions

Preoperative CBCT-guided micro-coil localization, is a safe and cheap procedure, allows the detection of GGOs, small or deep nodules in U-VATS with low rate of conversion to thoracotomy and few complications, without any use of intraoperatory radiations.

Precision CT‑guided marking with India ink and microcoils for laparoscopic resection of a lateral lymph node recurrence of rectal cancer: A case report

Although rarely used in laparoscopic surgery, computed tomography (CT)-guided marking is useful for targeting small lesions. The present study describes the performance of laparoscopic resection with preoperative CT-guided marking for lateral lymph node recurrence of rectal cancer. A 48-year-old man underwent laparoscopic low anterior resection with D3 lymph node dissection for rectal cancer (postoperative diagnosis, stage IIIb). Postoperative adjuvant chemotherapy was then administered. Solitary lymph node recurrence was observed in the left lateral region after 6 months. Systemic chemotherapy reduced the size of the metastatic lymph nodes; however, 3.5 years after the surgery, the diameter increased by 10 mm, and laparoscopic resection was thus planned. Because the target lesion was small and located deep in the pelvis, preoperative CT-guided marking was performed with India ink injection and embolization microcoil implantation. The markers were clearly identified and the lesion was successfully resected with adequate margins. The approach described in the present study is thus considered potentially useful for the detection of small lesions.

Combined indocyanine green and medical glue enables stable and precise position in animal studies: promising for fluorescence-guided pulmonary ground glass nodule resection

Background

Accurate preoperative localization of pulmonary nodules is crucial for surgical treatment. The use of indocyanine green (ICG) for localization is prone to thoracic contamination and spread, resulting in the eventual failure of localization. By using medical glue combined with ICG, we can accurately and permanently locate various tissues in animal study, which can provide evidences for clinical translations.

Methods

A series of medical glue and ICG volume ratios of 2:3, 3:3, 4:3, 6:3, and 9:3 were mixed and injected immediately into subcutaneous tissues of BALB/c nude mice; either medical glue or ICG was injected singly in the control group. Fluorescence intensity over time and boundary sharpness were investigated to determine the optimal ratio. Then, fluorescence guided resection of tissue was performed ex vivo on the pig intestine utilizing optimal ratio. Further, localization agents with the optimal ratio were injected into the organs of living mice, and fluorescence imaging for accurate positioning was performed 24 hours later.

Results

The localization agents with a volume ratio of 4:3 showed the best boundary sharpness and the strongest photostability. With the guidance of fluorescence navigation, the marked tissues were accurately separated and removed from the surrounding tissue both on mice and on pig intestines. In the organs of living mice, the localization agents (ratio 4:3) realized accurate positioning of marked tissues. Additionally, the medical glue limited the diffusion of ICG, promising to enable more stable and precise positioning of the nodules during surgery.

Conclusions

The combination of ICG and medical glue presents a superior approach when compared to the individual use of either ICG or medical glue. This technique offers enhanced precision and durability and sealed the wound, thereby mitigating the risk of pneumothorax following puncture procedures. This innovative technique optimizes the properties of medical adhesive to augment tissue density while harnessing the real-time fluorescent endoscopic marking capabilities of ICG during surgical interventions. By employing this innovative technique, it holds significant promise for augmenting the accuracy of pulmonary nodule localization in thoracoscopic surgery within future clinical applications.