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Marking method for peripheral non-palpable pulmonary nodules using a mobile computed tomography scanner with a navigation system

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Abstract

Intraoperative localization is essential for video-assisted thoracoscopic surgery of non-palpable pulmonary nodules. Although a computed tomography (CT) guided hook-wire localization is widely used, it might be accompanied by a rare but fatal complication such as an air embolism. We applied a mobile CT scanner with a navigation system to resolve this problem. The three-dimensional images obtained by the mobile CT scanner were transferred to the navigation system, which allowed for virtual fluoroscopy to scan the nearest skin site from the target lesion using a navigation probe. The lung surface was stamped by a dyed gauze ball anchored just beneath the skin marking and a needle was placed at this point as a landmark. With this method, we could verify the positional relationship between the needle and target lesion by the additional CT scan without any procedure-related morbidity.

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Acknowledgements

The authors thank the department of Clinical Engineering of our hospital for their contribution to establish this method.

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Authors and Affiliations

  1. Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, Naka-ku Sumiyoshi 2-12-12, Hamamatsu, Shizuoka, 430-8558, Japan

    Ryo Fujikawa & Toru Nakamura

  2. Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan

    Yoshiro Otsuki

  3. Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan

    Hidenori Nakamura

  4. First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Kazuhito Funai

Authors
  1. Ryo Fujikawa
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  2. Yoshiro Otsuki
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  3. Hidenori Nakamura
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  4. Kazuhito Funai
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  5. Toru Nakamura
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Correspondence to Ryo Fujikawa.

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The overview of the marking and surgery. The three-dimensional images obtained by the mobile computed tomography scanner were linked to the motion of the hand probe via the navigation system. We anchored a gauze ball containing gentian violet dye on the parietal pleura just beneath the skin marking and expanded the collapsed lung to stamp on the lung surface. We confirmed the positional relationship between the needle placed at this stamped dye and the target lesion with the mobile computed tomography scanner and performed a wedge resection of the marked lung subsequently. (MP4 21472 kb)

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

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  • DOI: https://doi.org/10.1007/s11748-020-01332-3

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