Abstract
With the widespread availability of lung cancer screening programs, the number of small lung nodules requiring histological characterization has dramatically increased. Because computed tomography–guided fine-needle aspiration may frequently yield false-negative results, excisional biopsy using thoracoscopy is frequently required. Although thoracoscopic procedure has been known to be ideal for nodule resection, the identification of very small, subsolid and deep pulmonary nodules may still be challenging. Precise lesion localization is a key prerequisite to avoid conversion to an unplanned thoracotomy. In the traditional workflow, the localization procedure is performed in the radiology suite, after which the patient is moved to an operating room. With the availability of hybrid operating rooms, a new approach encompassing simultaneous localization and removal of non-palpable lung nodules has become feasible. In this article, we review the procedural workflow of this new technique and discuss its indications and results.
Similar content being viewed by others
References
Gill RR, Zheng Y, Barlow JS, et al. Image-guided video assisted thoracoscopic surgery (iVATS) – phase I-II clinical trial. J Surg Oncol. 2015;112:18–25.
Zhao ZR, Lau RWH, Yu PSY, Ng CSH. Devising the guidelines. The techniques of pulmonary nodule localization in uniportal video-assisted thoracic surgery-hybrid operating room in the future. J Thorac Dis. 2019;11:S2073–8.
Park CH, Han K, Hur J, et al. Comparative effectiveness and safety of preoperative lung localization for pulmonary nodules. A systematic review and meta-analysis. Chest. 2017;151:316–28.
Stanzi A, Mazza F, Lucio F, et al. Tailored intraoperative localization of non-palpable pulmonary lesions for thoracoscopic wedge resection using hybrid room technology. Clin Respir J. 2018;12:1661–7.
Hsieh MJ, Wen CT, Fang HY, Wen YW, Lin CC, Chao YK. Learning curve of image-guided video-assisted thoracoscopic surgery for small pulmonary nodules: a prospective analysis of 30 initial patients. J Thorac Cardiovasc Surg. 2018;155:1825–32.e1.
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.
Yang SM, Ko WC, Lin MW, et al. Image-guided thoracoscopic surgery with dye localization in a hybrid operating room. J Thorac Dis. 2016;8:S681–9.
Kostrzewa M, Kara K, Rathmann N, et al. Computed tomography-assisted thoracoscopic surgery. A novel, innovative approach in patients with deep intrapulmonary lesions of unknown malignant status. Invest Radiol. 2017;52:374–80.
Fang HY, Chao YK, Hsieh MJ, et al. Image-guided video-assisted thoracoscopic surgery for small ground glass opacities: a case series. J Vis Surg. 2017;3:142.
Wen CT, Liu YY, Fang HY, Hsieh MJ, Chao YK. Image-guided video-assisted thoracoscopic small lung tumor resection using near-infrared marking. Surg Endosc. 2018;32:4673–80.
Chao YK, Wen CT, Fang HY, Hsieh MJ. A single-center experience of 100 image-guided video-assisted thoracoscopic surgery procedures. J Thorac Dis. 2018;10:S1624–30.
Fumimoto S, Sato K, Koyama M, et al. Combined lipiodol marking and video-assisted thoracoscopic surgery in a hybrid operating room. J Thorac Dis. 2018;10:2940–7.
Yu PSY, Chu CM, Lau RWH, et al. Video-assisted thoracic surgery for tiny pulmonary nodules with real-time image guidance in the hybrid theatre: the initial experience. J Thorac Dis. 2018;10:2933–9.
Leow OQY, Chao YK. Individualized strategies for intraoperative localization of non-palpable pulmonary nodules in a hybrid operating room. Front Surg. 2019;6:32.
Gill RR, Barlow J, Jaklitsch MT, Schmidlin EJ, Hartigan PM, Bueno R. Image-guided video-assisted thoracoscopic resection (iVATS): translation to clinical practice-real-world experience. J Surg Oncol. 2020;121:1225–32.
Chen PH, Hsu HH, Yang SM, et al. Preoperative dye localization for thoracoscopic lung surgery: hybrid versus computed tomography room. Ann Thorac Surg. 2018;106:1661–7.
Chao YK, Pan KT, Wen CT, Fang HY, Hsieh MJ. A comparison of efficacy and safety of preoperative versus intraoperative computed tomography-guided thoracoscopic lung resection. J Thorac Cardiovasc Surg. 2018;156:S1974–83.e1.
Ujiie H, Effat A, Yasufuku K. Image-guided thoracic surgery in the hybrid operation room. J Vis Surg. 2017;3:148.
Anayama T, Hirohashi K, Okada H, et al. Simultaneous cone beam computed tomography-guided bronchoscopic marking and video-assisted thoracoscopic wedge resection in a hybrid room. Thorac Cancer. 2019;10:579–82.
Schroeder C, Chung JM, Mitchell AB, Dillard TA, Radaelli AG, Schampaert S. Using the hybrid operating room in thoracic surgery. A paradigm shift. Innovations. 2018;13:372–7.
Funding
It is certified that the present study is not funded by any association/firm in any manner.
Author information
Authors and Affiliations
Contributions
GM had the idea for the article. MV, FM and DT performed the literature search and critically revised the work.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval, Statement regarding research involving human participants and or animals and informed consent
Not required as this is a review article.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Melloni, G., Venturino, M., Mazza, F. et al. Use of the hybrid room for thoracic surgery procedures: single-stage localization and removal of non-palpable nodules. Indian J Thorac Cardiovasc Surg 37, 70–77 (2021). https://doi.org/10.1007/s12055-020-00997-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12055-020-00997-y