Computed Tomography-Assisted Thoracoscopic Surgery for Deep Intrapulmonary Lesions. A Novel Approach

Eric D. Roessner, Micahel Kostrzewa

University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany

Date, time and location: 2018.05.26 13:30, Congress Hall, 2F–C

Abstract

Objectives: Minimally invasive resection of small, deep intrapulmonary lesions can be challenging due to the difficulty of localizing them during video-assisted thoracoscopic surgery (VATS). We report our results observational study on image-guided, minimally invasive, 1-stop-shop approach for the resection of small, deep intrapulmonary lesions in a hybrid operating room (OR).

Materials and Methods: Twenty seven patients (11 men, 16 women; mean age, 63 years) with a total of 28 deep intrapulmonary nodules of unknown malignant status were identified for intraoperative wire marking. Patients were placed on the operating table for resection by VATS. A marking wire was placed within the lesion under 3D laser and fluoroscopic guidance using a cone beam computed tomography system. Then, wedge resection by VATS was performed in the same setting without repositioning the patient. 

Results: Complete resection with adequate safety margins was confirmed for all lesions. Marking wire placement facilitated resection in 27 of 28 lesions. Twenty lesions proved to be malignant, either primary or secondary; 7 were benign. Mean lesion size was 7.7 mm; mean distance to the pleural surface was 15.9 mm (mean lesion depth–diameter ratio, 2.1). Mean procedural time for marking wire placement was 31 minutes; mean VATS duration was 34.7 minutes. 

Conclusions: Computed tomography–assisted thoracoscopic surgery is a new, safe, and effective procedure for minimally invasive resection of small, deeply localized intrapulmonary lesions. The benefits of computed tomography–assisted thoracoscopic surgery are 1. One-stop-shop procedure, 2. Lower risk for the patient (no patient relocation, no marking wire loss), and 3. No need to coordinate scheduling between the CT room and OR.