Localizing small lung lesions in video-assisted thoracoscopic surgery via radiofrequency identification marking
- 356 Downloads
To facilitate accurate localization of small lung lesions in thoracoscopic surgery, we employed a micro-radiofrequency identification tag designed to be delivered through the 2-mm working channel of a flexible bronchoscope. This report presents the results of preclinical studies of our novel localizing technique in a canine model.
To evaluate functional placement, three types of tags [Group A, tag alone (n = 18); Group B, tag + resin anchor (n = 15); and Group C, tag + NiTi coil anchor (n = 15)] were bronchoscopically placed in subpleural areas and subsegmental bronchi via our new delivery device; tags were examined radiographically on days 0–7 and day 14. In addition, eight tags, which were placed at a mean depth of 13.3 mm (range 9–15.7 mm) from visceral pleura in bronchi with a mean diameter of 1.46 mm (range 0.9–2.3 mm), were recovered by partial lung resection under video-assisted thoracoscopic surgery using a 13.56-MHz wand-shaped probe with a 30-mm communication range.
Peripheral airway placement: Group C had a significantly higher retention rate than the other two groups (retention rate at day 14: Group A, 11.1 %; Group B, 26.7 %; Group C, 100.0 %; P < 0.0001). Central airway placement: Overall retention rate was 73.3 % in Group C, and placement was possible in bronchi of up to 3.3 mm in diameter. Outcomes of partial resection: Tag recovery rate was 100 %, mean time required for tag detection was 10.8 s (range 8–15 s), and mean surgical margin from the delivered tag was 9.13 mm (range 6–13 mm).
Radiofrequency identification marking enabled accurate localization with depth, which could ensure effective deep resection margins.
KeywordsRadiofrequency identification tag Localization Small lung lesion Video-assisted thoracoscopic surgery Wedge resection Surgical navigation
We wish to thank Seiki Hasegawa (Hyogo College of Medicine, Hyogo, Japan), Tatsuo Nakagawa (Tenri Hospital, Nara, Japan), and Hiromichi Katakura (Otsu Red Cross Hospital, Shiga, Japan) for providing valuable suggestions regarding this project.
Hogy Medical Co., Ltd. provided the radiofrequency identification system and financial support by means of an institutional research grant.
Compliance with ethical standards
We guarantee that all authors are aware of and agree to the contents of the paper and their being listed as an author on this paper. All authors have contributed significantly to the content of the article. All authors have read and approved the submission of the manuscript to Surgical Endoscopy. Subject to acceptance, authors will sign an exclusive license to publish. Drs. J. Zhang, Y. Muranishi, Y. Sakaguchi, T. Komatsu, F. Kojima, and T. Nakamura have no conflicts of interest or financial ties to disclose. Y. Yutaka, T, Sato, and H. Date have a financial relationship with Hogy Medical Co., Ltd., which developed the radiofrequency identification system used in this study. The results were collected and analyzed independent from any sponsor.
A marking tag placed at a depth of 13.3 mm in left S6 as indicated on computed tomography was recovered by video-assisted thoracoscopic surgery partial lung resection. The implanted tag was detected in the plastic grasper. The lung was resected by electrocautery with accurate adjustment of the resection line by detecting tag position. (MP4 42859 kb)
- 2.Veronesi G, Maisonneuve P, Rampinelli C, Bertolotti R, Petrella F, Spaggiari L, Bellomi M (2013) Computed tomography screening for lung cancer: results of ten years of annual screening and validation of cosmos prediction model. Lung Cancer 82(3):426–430. doi: 10.1016/j.lungcan.2013.08.026 CrossRefPubMedGoogle Scholar
- 3.Menezes RJ, Roberts HC, Paul NS, McGregor M, Chung TB, Patsios D, Weisbrod G, Herman S, Pereira A, McGregor A, Dong Z, Sitartchouk I, Boerner S, Tsao MS, Keshavjee S, Shepherd FA (2010) Lung cancer screening using low-dose computed tomography in at-risk individuals: the Toronto experience. Lung Cancer 67(2):177–183. doi: 10.1016/j.lungcan.2009.03.030 CrossRefPubMedGoogle Scholar
- 4.Bach PB, Mirkin JN, Oliver TK, Azzoli CG, Berry DA, Brawley OW, Byers T, Colditz GA, Gould MK, Jett JR, Sabichi AL, Smith-Bindman R, Wood DE, Qaseem A, Detterbeck FC (2012) Benefits and harms of CT screening for lung cancer: a systematic review. JAMA 307(22):2418–2429. doi: 10.1001/jama.2012.5521 CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Masuda M, Kuwano H, Okumura M, Arai H, Endo S, Doki Y, Kobayashi J, Motomura N, Nishida H, Saiki Y, Tanaka F, Tanemoto K, Toh Y, Yokomise H (2015) Thoracic and cardiovascular surgery in Japan during 2013: annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg 63(12):670–701. doi: 10.1007/s11748-015-0590-3 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Zaman M, Bilal H, Woo CY, Tang A (2012) In patients undergoing video-assisted thoracoscopic surgery excision, what is the best way to locate a subcentimetre solitary pulmonary nodule in order to achieve successful excision? Interact Cardiovasc Thorac Surg 15(2):266–272. doi: 10.1093/icvts/ivs068 CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Watanabe K, Nomori H, Ohtsuka T, Kaji M, Naruke T, Suemasu K (2006) Usefulness and complications of computed tomography-guided lipiodol marking for fluoroscopy-assisted thoracoscopic resection of small pulmonary nodules: experience with 174 nodules. J Thorac Cardiovasc Surg 132(2):320–324. doi: 10.1016/j.jtcvs.2006.04.012 CrossRefPubMedGoogle Scholar
- 13.Miyoshi T, Kondo K, Takizawa H, Kenzaki K, Fujino H, Sakiyama S, Tangoku A (2006) Fluoroscopy-assisted thoracoscopic resection of pulmonary nodules after computed tomography-guided bronchoscopic metallic coil marking. J Thorac Cardiovasc Surg 131(3):704–710. doi: 10.1016/j.jtcvs.2005.09.019 CrossRefPubMedGoogle Scholar
- 14.Kojima F, Sato T, Takahata H, Okada M, Sugiura T, Oshiro O, Date H, Nakamura T (2014) A novel surgical marking system for small peripheral lung nodules based on radio frequency identification technology: feasibility study in a canine model. J Thorac Cardiovasc Surg 147(4):1384–1389. doi: 10.1016/j.jtcvs.2013.05.048 CrossRefPubMedGoogle Scholar
- 15.Takahata H, Kojima F, Okada M, Sugiura T, Sato T, Oshiro O (2012) Thoracoscopic surgery support system using passive RFID marker. In: Conference proceedings: annual international conference of the IEEE engineering in medicine and biology society IEEE engineering in medicine and biology society annual conference, pp 183–186. doi: 10.1109/embc.2012.6345901
- 16.Landreneau RJ, Sugarbaker DJ, Mack MJ, Hazelrigg SR, Luketich JD, Fetterman L, Liptay MJ, Bartley S, Boley TM, Keenan RJ, Ferson PF, Weyant RJ, Naunheim KS (1997) Wedge resection versus lobectomy for stage I (T1 N0 M0) non-small-cell lung cancer. J Thorac Cardiovasc Surg 113(4):691–698. doi: 10.1016/s0022-5223(97)70226-5 (discussion 698–700) CrossRefPubMedGoogle Scholar
- 19.Jaklitsch MT, Jacobson FL, Austin JH, Field JK, Jett JR, Keshavjee S, MacMahon H, Mulshine JL, Munden RF, Salgia R, Strauss GM, Swanson SJ, Travis WD, Sugarbaker DJ (2012) The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. J Thorac Cardiovasc Surg 144(1):33–38. doi: 10.1016/j.jtcvs.2012.05.060 CrossRefPubMedGoogle Scholar
- 20.Gould MK, Donington J, Lynch WR, Mazzone PJ, Midthun DE, Naidich DP, Wiener RS (2013) Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143(5 Suppl):e93S–e120S. doi: 10.1378/chest.12-2351 CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Sato M, Omasa M, Chen F, Sato T, Sonobe M, Bando T, Date H (2014) Use of virtual assisted lung mapping (VAL-MAP), a bronchoscopic multispot dye-marking technique using virtual images, for precise navigation of thoracoscopic sublobar lung resection. J Thorac Cardiovasc Surg 147(6):1813–1819. doi: 10.1016/j.jtcvs.2013.11.046 CrossRefPubMedGoogle Scholar
- 27.Dendo S, Kanazawa S, Ando A, Hyodo T, Kouno Y, Yasui K, Mimura H, Akaki S, Kuroda M, Shimizu N, Hiraki Y (2002) Preoperative localization of small pulmonary lesions with a short hook wire and suture system: experience with 168 procedures. Radiology 225(2):511–518. doi: 10.1148/radiol.2252011025 CrossRefPubMedGoogle Scholar
- 31.Dauphine C, Reicher JJ, Reicher MA, Gondusky C, Khalkhali I, Kim M (2015) A prospective clinical study to evaluate the safety and performance of wireless localization of nonpalpable breast lesions using radiofrequency identification technology. AJR Am J Roentgenol 204(6):W720–W723. doi: 10.2214/ajr.14.13201 CrossRefPubMedGoogle Scholar
- 35.Anantham D, Feller-Kopman D, Shanmugham LN, Berman SM, DeCamp MM, Gangadharan SP, Eberhardt R, Herth F, Ernst A (2007) Electromagnetic navigation bronchoscopy-guided fiducial placement for robotic stereotactic radiosurgery of lung tumors: a feasibility study. Chest 132(3):930–935. doi: 10.1378/chest.07-0522 CrossRefPubMedGoogle Scholar
- 36.Anayama T, Qiu J, Chan H, Nakajima T, Weersink R, Daly M, McConnell J, Waddell T, Keshavjee S, Jaffray D, Irish JC, Hirohashi K, Wada H, Orihashi K, Yasufuku K (2015) Localization of pulmonary nodules using navigation bronchoscope and a near-infrared fluorescence thoracoscope. Ann Thorac Surg 99(1):224–230. doi: 10.1016/j.athoracsur.2014.07.050 CrossRefPubMedGoogle Scholar
- 37.Toba H, Kondo K, Miyoshi T, Kajiura K, Yoshida M, Kawakami Y, Takizawa H, Kenzaki K, Sakiyama S, Tangoku A (2013) Fluoroscopy-assisted thoracoscopic resection after computed tomography-guided bronchoscopic metallic coil marking for small peripheral pulmonary lesions. Eur J Cardio Thorac Surg 44(2):e126–e132. doi: 10.1093/ejcts/ezt220 CrossRefGoogle Scholar
- 38.Petersen J, Wille MM, Raket LL, Feragen A, Pedersen JH, Nielsen M, Dirksen A, de Bruijne M (2014) Effect of inspiration on airway dimensions measured in maximal inspiration CT images of subjects without airflow limitation. Eur Radiol 24(9):2319–2325. doi: 10.1007/s00330-014-3261-3 CrossRefPubMedGoogle Scholar