Image-guided thoracoscopic surgery with dye localization in a hybrid operating room

Area of Science:

• Thoracic Surgery
• Medical Imaging
• Interventional Pulmonology

Background:

• The detection rate of small pulmonary nodules (SPNs) is increasing.
• Image-guided localization followed by thoracoscopic resection is a reliable treatment for SPNs.
• A novel technique using robotic C-arm CT for dye localization and VATS in a hybrid OR is presented.

Purpose of the Study:

• To evaluate the feasibility and safety of robotic C-arm CT-guided dye localization followed by immediate video-assisted thoracoscopic surgery (VATS) for SPNs.
• To assess the efficacy of this novel procedure in a hybrid operating room (OR).

Main Methods:

• Retrospective review of 25 consecutive patients with SPNs (<2 cm) from July 2015 to July 2016.
• Robotic C-arm CT-guided blue dye tattooing followed by immediate VATS in a hybrid OR.
• Evaluation of procedure success, operative times, pathological diagnoses, and complications.

Main Results:

• Successful dye localization in 92% of patients (23/25).
• All 25 patients underwent successful lesion resection; median nodule size was 1.0 cm.
• Median localization and surgery times were 46 and 109 minutes, respectively; no operative mortality.
• Pathological diagnoses included lung adenocarcinoma (72%), benign tumors (20%), and metastases (8%).
• Median postoperative stay was 3 days; 8% complication rate (diaphragm injury, pneumonia), managed conservatively.

Conclusions:

• Robotic C-arm CT-guided dye localization followed by immediate VATS in a hybrid OR is safe and feasible for managing SPNs.
• This technique represents an effective and attractive alternative for SPN treatment.
• The study highlights the potential of advanced imaging and robotic technology in thoracic surgery.