1. Image-Guided VATS in the Hybrid Operation Room Facilitates Early Diagnosis and Concurrent Treatment of Subcentimeter Nonpalpable Lung Nodules.
- Author
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Partlow J, Thomas S, Nicolini M, Greeno S, and Schroeder C
- Subjects
- Humans, Male, Aged, Middle Aged, Female, Bronchoscopy methods, Operating Rooms, Early Detection of Cancer methods, Carcinoma, Non-Small-Cell Lung surgery, Carcinoma, Non-Small-Cell Lung diagnostic imaging, Carcinoma, Non-Small-Cell Lung pathology, Tomography, X-Ray Computed methods, Cone-Beam Computed Tomography methods, Fluoroscopy methods, Solitary Pulmonary Nodule surgery, Solitary Pulmonary Nodule diagnostic imaging, Solitary Pulmonary Nodule pathology, Multiple Pulmonary Nodules surgery, Multiple Pulmonary Nodules diagnostic imaging, Multiple Pulmonary Nodules pathology, Surgery, Computer-Assisted methods, Lung Neoplasms surgery, Lung Neoplasms diagnostic imaging, Lung Neoplasms pathology, Thoracic Surgery, Video-Assisted methods
- Abstract
Objective: As lung cancer screening increases, the detection of small, nonpalpable lung lesions is on the rise. The hybrid operation room (OR), which combines percutaneous or endobronchial fiducial placement with on-table computed tomography (CT) and fluoroscopic guidance, improves localization and facilitates the diagnosis and treatment of smaller, nonpalpable lung nodules with greater accuracy., Methods: In 35 consecutive months, 55 veterans underwent 60 image-guided video-assisted thoracic surgery procedures for lesion resection. Of the cases, 36% were found during lung cancer screening. All patients received their care in the hybrid OR, where cone-beam CT scan technology was used to place an average of 1.6 fiducials percutaneously ( n = 55) or via augmented navigational bronchoscopy ( n = 5)., Results: A total of 66 lesions were resected. The median lesion size was 8 mm with an interquartile range of 6 to 14. The patients underwent nonanatomical resection with lymph node dissection using radiologic guidance. When indicated, an anatomical resection was subsequently performed. Of 47 total non-small cell lung cancer lesions, 83% were diagnosed at stage IA1 or IA2. The median surgical margin was 15 mm; the margin was usually 1.5 times as wide as the lesion., Conclusions: The hybrid OR technology gives a 3-dimensional assessment of the small lung lesions, allowing for a tissue-saving resection while achieving good surgical margins. During lung cancer screening, smaller, nonpalpable lung nodules are frequently found. This technology allows resection of subcentimeter lesions, which would otherwise be unresectable at this early stage, possibly improving survival., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2024
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