Abstract
Background
Video-assisted thoracic surgery (VATS) provides a minimally invasive means to resect small pulmonary nodules (SPN). However, thoracoscopy has limits in the detection of small nodules, which are invisible and/or impalpable during surgery. Methods to localize such lesions, including methylene blue injection or the introduction of a hookwire under the guidance of computed tomography (CT), have some limitations. We are developing a new technique using image-guided navigation system for localization of small pulmonary nodules before thoracoscopic surgery.
Methods
Four pigs underwent spiral-computed tomography (CT) scanning after they were given percutaneously created pulmonary lesions. The CT data were transmitted to a StealthStation navigation system, and with the help of the probe the lesions were located and resected under thoracoscopy.
Results
A total of 20 lesions were created. Nodules were located at an average distance of 15.6 mm from the pleural surface. All the lesions were successfully localized, and biopsy specimens revealed successful resection of target material.
Conclusion
This method can provide appropriate guidance to small pulmonary nodules and prove effective in immediately facilitating subsequent thoracoscopic resection.
Similar content being viewed by others
References
Ambrogi MC, Dini P, Boni G, Melfi F, Lucchi M, Fanucchi O, Mariani G, Mussi A (2005) A strategy for thoracoscopic resection of small pulmonary nodules. Surg Endosc 19:1644–1647
Carcoforo P, Feo C, Sortini D, Pozza E, Carrella G, Sortini A (2004) Localization of pulmonary nodules. Chest 125:796–797
Ciriaco P, Negri G, Puglisi A, Nicoletti R, Del Maschio A, Zannini P (2004) Video-assisted thoracoscopic surgery for pulmonary nodules: rationale for preoperative computed tomography-guided hookwire localization. Eur J Cardiothorac Surg 25:429–433
Confalonieri N, Manzotti A (2004) Navigation and robots. J Orthopaed Traumatol 5:137–141
Giraud P, Yorke E, Ford EC, Wagman R, Mageras GS, Amols H, Ling CC, Rosenzweig KE (2006) Reduction of organ motion in lung tumors with respiratory gating. Lung Cancer 51:41–51
Kerrigan DC, Spence PA, Crittenden MD, Tripp MD (1992) Methylene blue guidance for simplified resection of a lung lesion. Ann Thorac Surg 53:163–164
Mah D, Hanley J, Rosenzweig KE, Yorke E, Braban L, Ling CC, Leibel SA, Mageras G (2000) Technical aspects of the deep inspiration breath-hold technique in the treatment of thoracic cancer. Int J Radiat Oncol Biol Phys 48:1175–1185
Marvik R, Lango T, Tangen GA, Andersen JO, Kasperen JH, Ystgaard B, Sjolie E, Fougner R, Fjosne HE, Nagelhus Hernes TA (2004) Laparoscopic navigation pointer for three-dimensional image-guided surgery. Surg Endosc 18:1242–1248
Mayberg MR, LaPresto E, Cunningham EJ (2005) Image-guided endoscopy: description of technique and potential applications. Neurosurg Focus 19:E10
Onishi H, Kuriyama K, Komiyama T, Tanaka S, Ueki J, Sano N, Araki T, Ikenaga S, Tateda Y, Aikawa Y (2003) CT evaluation of patient deep inspiration self-breath-holding: how precisely can patients reproduce the tumor position in the absence of respiratory monitoring devices? Med Phys 30:1183–1187
Park BJ, Flores RM, Rusch VW (2006) Robotic assistance for video-assisted thoracic surgical lobectomy: technique and initial results. J Thorac Cardiovasc Surg 131:54–59
Partik BL, Leung AN, Muller MR, Breitenseher M, Eckersberger F, Dekan G, Helbich TH, Metz V (2003) Using a dedicated lung-marker system for localization of pulmonary nodules before thoracoscopic surgery. Am J Roentgenol 180:805–809
Reittner P, Tillich M, Luxenberger W, Weinke R, Preidler K, Kole W, Stammberger H, Szolar D (2002) Multislice CT-image-guided endoscopic sinus surgery using an electromagnetic tracking system. Eur Radiol 12:592–596
Saito H, Minamiya Y, Matsuzaki I, Tozawa K, Taguchi K, Nakagawa T, Hashimoto M, Hirano Y, Ogawa J (2002) Indication for preoperative localization of small peripheral pulmonary nodules in thoracoscopic surgery. J Thorac Cardiovasc Surg 124:1198–1202
Sortini D, Feo CV, Carcoforo P, Carrella G, Pozza E, Liboni A, Sortini A (2005) Thoracoscopic localization techniques for patients with solitary pulmonary nodule and history of malignancy. Ann Thorac Surg 79:258–262
Sugi K, Kaneda Y, Hirasawa K, Kunitani N (2003) Radioisotope marking under CT guidance and localization using a handheld gamma probe for small or indistinct pulmonary lesions. Chest 124:155–158
Acknowledgments
The authors acknowledge the contributions of Dr. Congwen Zhuang, Department of Thoracic and Cardiovascular Surgery, Fuzhou General Hospital, Fuzhou; and Thomas Lang (PhD, Research Scientist) and Frank Lindseth (Research Scientist) from SINTEF Health Research, Trondheim, Norway, for their help. The project was supported by the Natural Science Foundation of Fujian Province of China (No. 2006J0369)
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chen, W., Chen, L., Qiang, G. et al. Using an image-guided navigation system for localization of small pulmonary nodules before thoracoscopic surgery. Surg Endosc 21, 1883–1886 (2007). https://doi.org/10.1007/s00464-007-9198-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-007-9198-8