SESSION TYPE: Diagnostic Bronchoscopy
PRESENTED ON: Tuesday, October 23, 2012 at 04:30 PM - 05:45 PM
PURPOSE: In thoracoscopic surgery, the identification of a lesion during the operation is important. It had been reported that the lesions that have diameters of <10 mm and that are >5 mm from the pleura were very difficult to thoracoscopically detected. To facilitate marking and to reduce its complications, we performed thin bronchoscopic coil-marking using virtual bronchoscopic navigation (VBN) with endbronchial ultrasound before fluoroscopy-assisted thoracoscopic surgery. We then evaluated the feasibility, safety, and efficacy of this technique.
METHODS: Enrolled all subjects were consecutive patients with small pulmonary peripheral lesions (<15 mm) showing a CT scan-confirmed ground-glass opacity pattern who were referred to Kameda Medical Center for thoracoscopic surgery between June 2011 and March 2012. VB images to the planned marking sites near each lesion were produced from helical CT scan data. Based on these images, a thin bronchoscope was advanced to the target bronchus as far as possible in this pathway. Radial EBUS (R-EBUS) probe was then advanced to the target lesion under radiologic fluoroscopy guidance. After visualization of the lesion by R-EBUS, the probe was removed leaving the guide sheath in place, and platinum vascular coil was pushed to the target by guidewire and indwelling under fluoroscopy-assisted.
RESULTS: Our study included 4 patients (4 females) with 4 lesions, mean age 69 years. The mean lesion size was 11.8mm in diameter. Pathologic studies revealed primary lung cancer in all lesions. Bronchoscopic coil-marking was achieved without causing complications in any of the patients. The median shortest distance between the coil- marker and the lesion was 3mm (within 5 mm in 4 lesions). In patients undergoing thoracoscopic surgery, all coil-marked sites were identified by intraoperative radiographic fluoroscopy, and all lesions were resected.
CONCLUSIONS: This method can be readily performed and is a useful marking method before fluoroscopy-assisted thoracoscopic surgery.
CLINICAL IMPLICATIONS: This new preoperative marking method may be an indication for small peripheral pulmonary lesions showing a CT scan-confirmed ground-glass opacity pattern.
DISCLOSURE: The following authors have nothing to disclose: Masafumi Misawa, Motoji Fukasawa, Masaru Abe, Hideki Makino, Masahiro Aoshima, Akihiko Takeshi
No Product/Research Disclosure InformationKameda Medical Center, Kamogawa City, Japan