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Surgical Endoscopy
Published in: Surgical Endoscopy 11/2018

01-11-2018 | Dynamic Manuscript

Image-guided video-assisted thoracoscopic small lung tumor resection using near-infrared marking

Authors: Chih-Tsung Wen, Yu-Yin Liu, Hsin-Yueh Fang, Ming-Ju Hsieh, Yin-Kai Chao

Published in: Surgical Endoscopy | Issue 11/2018

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Abstract

Background

Localization of non-visible, non-palpable small pulmonary nodules during video-assisted thoracoscopic surgery (VATS) remains challenging. We sought to investigate the feasibility and safety of image-guided video-assisted thoracoscopic surgery (iVATS) with near-infrared (NIR) marking in a hybrid operating room (OR).

Methods

Both localization and surgery were performed by a single team of thoracic surgeons. Diluted indocyanine green (ICG; quantity: 0.3–0.5 mL; dye concentration: 0.125 mg/mL) was injected percutaneously to pinpoint the tumor’s location under cone beam computed tomography (CBCT) guidance using a laser-guided navigation system. Real-time fluorescence images were intraoperatively obtained using a NIR thoracoscopic camera to guide subsequent resection.

Results

Between March and December 2017, 26 patients underwent NIR marking of small pulmonary nodules for iVATS. The median tumor size was 7 mm (interquartile range [IQR] 5.3–10.8 mm), whereas their median distance from the pleural surface was 5 mm (IQR 0.3–10.5 mm). Seven nodules (35%) were solid, whereas 17 (65%) were ground-glass opacities. All lesions were identifiable on intraoperative CBCT. The median time required for NIR localization was 13 min. An NIR(+) “tattoo” was identified in all cases, and no intraoperative conversion to thoracotomy occurred. The final pathological diagnoses were primary lung cancer (n = 11), metastatic cancer (n = 6), and benign lung tumor (n = 9). Adverse events were not observed, and the median length of post-operative stay was 4 days (IQR 3–4 days).

Conclusions

Our data show that iVATS with NIR marking is useful, has no adverse effects, and can successfully localize difficult-to-identify small pulmonary nodules.
Appendix
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Metadata
Title
Image-guided video-assisted thoracoscopic small lung tumor resection using near-infrared marking
Authors
Chih-Tsung Wen
Yu-Yin Liu
Hsin-Yueh Fang
Ming-Ju Hsieh
Yin-Kai Chao
Publication date
01-11-2018
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 11/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-6252-7

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