Skip to main content
SpringerLink
Log in

Augmented fluoroscopy-guided dye localization for small pulmonary nodules in hybrid operating room: intrathoracic stamping versus transbronchial marking

  • Original Article
  • Published:
International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

We developed a novel augmented fluoroscopy-guided intrathoracic stamping technique for localizing small pulmonary nodules in the hybrid operating room. We conducted an observational study to investigate the feasibility of this technique and retrospectively compared two augmented fluoroscopy-guided approaches: intrathoracic and transbronchial.

Methods

From August 2020 to March 2023, consecutive patients underwent single-stage augmented fluoroscopy-guided localization under general anaesthesia. This included intrathoracic stamping and bronchoscopic lung marking, followed by thoracoscopic resection in a hybrid operating room. Comparative analyses were performed between the two groups.

Results

The data of 50 patients in the intrathoracic stamping and 67 patients in the bronchoscopic lung marking groups were analysed. No significant difference was noted in demographic data between the groups, except a larger lesion depth in the bronchoscopic lung marking group (14.7 ± 11.7 vs 11.0 ± 5.8 mm, p = 0.029). Dye localization was successfully performed in 49 intrathoracic stamping group patients (98.0%) and 67 bronchoscopic lung marking group patients (100%). No major procedure-related complications occurred in either group; however, the time flow (total anaesthesia time/global operating room time) was longer, and the radiation exposure (fluoroscopy duration/total dose area product) was larger in the bronchoscopic lung marking group.

Conclusions

Augmented fluoroscopic stamping localization under intubated general anaesthesia is feasible and safe, providing an alternative with less global operating room time and lower radiation exposure for image-guided thoracoscopic surgery in the hybrid operating room.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The authors confirm that the data generated during and/or analysed during the current study and the raw data that support the findings in this study are available from the corresponding author upon reasonable request.

References

  1. National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, Gareen IF, Gatsonis C, Marcus PM, Sicks JD (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365:395–409. https://doi.org/10.1056/NEJMoa1102873

    Article  Google Scholar 

  2. Burzic A, O’Dowd EL, Baldwin DR (2022) The future of lung cancer screening: Current challenges and research priorities. Cancer Manag Res 14:637–645. https://doi.org/10.2147/CMAR.S293877

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lin MW, Chen JS (2016) Image-guided techniques for localizing pulmonary nodules in thoracoscopic surgery. J Thorac Dis 8:S749-S755. https://doi.org/10.21037/jtd.2016.09.71

  4. National Comprehensive Cancer Network (2020) NCCN Clinical Practice Guidelines in Oncology: Lung Cancer Screening; Version 1.2020. www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed 6 July 2023

  5. Zhao ZR, Lau RW, Ng CS (2016) Hybrid theatre and alternative localization techniques in conventional and single-port video-assisted thoracoscopic surgery. J Thorac Dis 8:S319-327. https://doi.org/10.3978/j.issn.2072-1439.2016.02.27

    Article  PubMed  PubMed Central  Google Scholar 

  6. Yang SM, Ko WC, Lin MW, Hsu HH, Chan CY, Wu IH, Chang YC, Chen JS (2016) Image-guided thoracoscopic surgery with dye localization in a hybrid operating room. J Thorac Dis 8:S681–S689. https://doi.org/10.21037/jtd.2016.09.55

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lempel JK, Raymond DP (2019) Intraoperative percutaneous microcoil localization of small peripheral pulmonary nodules using cone-beam CT in a hybrid operating room. AJR Am J Roentgenol 213:778–781. https://doi.org/10.2214/AJR.19.21175

    Article  PubMed  Google Scholar 

  8. Leow OQY, Chao YK (2019) Individualized strategies for intraoperative localization of non-palpable pulmonary nodules in a hybrid operating room. Front Surg 6:32. https://doi.org/10.3389/fsurg.2019.00032

    Article  PubMed  PubMed Central  Google Scholar 

  9. Park CH, Han K, Hur J, Lee SM, Lee JW, Hwang SH, Seo JS, Lee KH, Kwon W, Kim TH, Choi BW (2017) Comparative effectiveness and safety of preoperative lung localization for pulmonary nodules: a systematic review and meta-analysis. Chest 151:316–328. https://doi.org/10.1016/j.chest.2016.09.017

    Article  PubMed  Google Scholar 

  10. Chi CL, Gao X, Tai CC, Chao YK (2022) Preoperative percutaneous localization of multiple ipsilateral pulmonary nodules: a systematic review. Formos J Surg 55:81–86. https://doi.org/10.4103/fjs.fjs_108_22

    Article  Google Scholar 

  11. Starnes SL, Wolujewicz M, Guitron J, Williams V, Scheler J, Ristagno R (2018) Radiotracer localization of nonpalpable pulmonary nodules: a single-centre experience. J Thorac Cardiovasc Surg 156:1986–1992. https://doi.org/10.1016/j.jtcvs.2018.03.152

    Article  PubMed  Google Scholar 

  12. Saito Y (2022) Recent advances in electromagnetic navigation bronchoscopy for localization of peripheral pulmonary nodules. J Thorac Dis 14:802–804. https://doi.org/10.21037/jtd-22-179

    Article  PubMed  PubMed Central  Google Scholar 

  13. Yang SM, Yu KL, Lin JH, Lin KS, Liu YL, Sun SE, Meng LH, Ko HJ (2019) Cumulative experience of preoperative real-time augmented fluoroscopy-guided endobronchial dye marking for small pulmonary nodules: an analysis of 30 initial patients. J Formos Med Assoc 118:1232–1238. https://doi.org/10.1016/j.jfma.2019.04.017

    Article  PubMed  Google Scholar 

  14. Hogarth DK (2018) Use of augmented fluoroscopic imaging during diagnostic bronchoscopy. Future Oncol 14:2247–2252. https://doi.org/10.2217/fon-2017-0686

    Article  CAS  PubMed  Google Scholar 

  15. Cicenia J, Bhadra K, Sethi S, Nader DA, Whitten P, Hogarth DK (2021) Augmented fluoroscopy: a new and novel navigation platform for peripheral bronchoscopy. J Bronchology Interv Pulmonol 28:116–123. https://doi.org/10.1097/LBR.0000000000000722

    Article  PubMed  Google Scholar 

  16. Yang SM, Yu KL, Lin KH, Liu YL, Sun SE, Meng LH, Ko HJ (2020) Real-time augmented fluoroscopy-guided lung marking for thoracoscopic resection of small pulmonary nodules. Surg Endosc 34:477–484. https://doi.org/10.1007/s00464-019-06972-y

    Article  PubMed  Google Scholar 

  17. Kawada M, Okubo T, Poudel S, Suzuki Y, Kawarada Y, Kitashiro S, Okushiba S, Katoh H (2013) A new marking technique for peripheral lung nodules avoiding pleural puncture: the intrathoracic stamping method. Interact Cardiovasc Thorac Surg 16:381–383. https://doi.org/10.1093/icvts/ivs521

    Article  PubMed  Google Scholar 

  18. Yang SM, Chung WY, Ko HJ, Chen LC, Chang LK, Chang HC, Kuo SW, Ho MC (2023) Single-stage augmented fluoroscopic bronchoscopy localization and thoracoscopic resection of small pulmonary nodules in a hybrid operating room. Eur J Cardiothorac Surg 63:ezac541. https://doi.org/10.1093/ejcts/ezac541

    Article  Google Scholar 

  19. Yang SM, Yu KL, Lin KS, Liu YL, Sun SE, Meng LH, Ko HJ (2020) Localization of small pulmonary nodules using augmented fluoroscopic bronchoscopy: experience from 100 consecutive cases. World J Surg 44:2418–2425. https://doi.org/10.1007/s00268-020-05434-0

    Article  PubMed  Google Scholar 

  20. Kamiyoshihara M, Ibe T, Kawatani N, Ohsawa F, Yoshikawa R, Shimizu K (2016) A convenient method for identifying a small pulmonary nodule using a dyed swab and geometric mapping. J Thorac Dis 44:2418–2425. https://doi.org/10.21037/jtd.2016.08.62

    Article  Google Scholar 

  21. Fujikawa R, Otsuki Y, Nakamura H, Funai K, Nakamura T (2020) Marking method for peripheral non-palpable pulmonary nodules using a mobile computed tomography scanner with a navigation system. Gen Thorac Cardiovas Surg 68:1220–1223. https://doi.org/10.1007/s11748-020-01332-3

    Article  Google Scholar 

  22. Saito Y, Watanabe T, Kanamoto Y, Asami M, Yokote F, Dejima H, Morooka H, Ibi T, Yamauchi Y, Takahashi N, Ikeya T, Sakao Y, Kawamura M (2022) A pilot study of intraoperative localization of peripheral small pulmonary tumors by cone-beam computed tomography: sandwich marking technique. J Thorac Dis 14:2845–2854. https://doi.org/10.21037/jtd-22-190

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nagano M, Sato M (2023) Ten-year outcome and development of virtual-assisted lung mapping in thoracic surgery. Cancers (Basel) 15:1971. https://doi.org/10.3390/cancers15071971

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by a grant from the National Taiwan University Hospital, Hsin-Chu Branch, Taiwan [Grant Number 111-BIH008].

Author information

Authors and Affiliations

  1. Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan

    Shun-Mao Yang, Wen-Yuan Chung, Lun-Che Chen, Ling-Kai Chang, Hao-Chun Chang, Pak-Si Chan & Shuenn-Wen Kuo

  2. Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei, Hsinchu, 302, Taiwan

    Shun-Mao Yang, Wen-Yuan Chung, Wen-Ting Wu & Shuenn-Wen Kuo

  3. Department of Advanced Therapies, Siemens Healthcare Limited, Taipei, Taiwan

    Shwetambara Malwade

  4. Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan

    Lun-Che Chen, Ling-Kai Chang & Hao-Chun Chang

  5. Department of Anesthesiology, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan

    Pak-Si Chan

Authors
  1. Shun-Mao Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shwetambara Malwade
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wen-Yuan Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wen-Ting Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lun-Che Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ling-Kai Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hao-Chun Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Pak-Si Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shuenn-Wen Kuo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Shun-Mao Yang: Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Project administration; Resources; Software; Validation; Visualization; Writing—original draft; Writing—review & editing. Shwetambara Malwade: Investigation; Methodology; Data curation; Writing—original draft; Writing—review & editing. Wen-Yuan Chung: Data curation; Formal analysis; Project administration; Software; Visualization. Wen-Ting Wu: Data curation; Formal analysis; Project administration. Lun-Che Chen: Data curation; Formal analysis; Investigation; Project administration; Validation; Writing—review & editing. Ling-Kai Chang: Data curation; Formal analysis; Investigation; Methodology; Visualization; Writing—review & editing. Hao-Chun Chang: Data curation; Formal analysis; Investigation; Project administration; Writing—review & editing. Pak-Si Chan: Conceptualization; Data curation; Investigation; Project administration; Writing—review & editing. Shuenn-Wen Kuo: Conceptualization; Investigation; Methodology; Supervision; Writing—review & editing. All authors approved the final version of the manuscript.

Corresponding authors

Correspondence to Shun-Mao Yang or Shuenn-Wen Kuo.

Ethics declarations

Conflict of interest

Shwetambara Malwade works for Siemens Healthcare as a research scientist. Shun-Mao Yang, Wen-Yuan Chung, Wen-Ting Wu, Lun-Che Chen, Ling-Kai Chang, Hao-Chun Chang, Pak-Si Chan, and Shuenn-Wen Kuo have no conflicts of interest or financial ties to disclose.

Ethical approval

This study was performed in accordance with the principles of the Declaration of Helsinki and its later amendments. Approval was granted by the Research Ethics Committee of the National Taiwan University Hospital (approval number: 202304131RINC).

Informed consent

Individual consent for this retrospective analysis was waived.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, SM., Malwade, S., Chung, WY. et al. Augmented fluoroscopy-guided dye localization for small pulmonary nodules in hybrid operating room: intrathoracic stamping versus transbronchial marking. Int J CARS (2024). https://doi.org/10.1007/s11548-024-03146-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11548-024-03146-7

Keywords

Search

Navigation