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Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery
Published on: May 4, 2022
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Intraoperative electromagnetic navigational bronchoscopic localization of small, deep, or subsolid pulmonary nodules
Abbas Abbas1, Sagar Kadakia2, Vishnu Ambur2
1Department of Thoracic Medicine and Surgery, Temple University Hospital, Lewis Katz School of Medicine, Philadelphia, Pa.
The Journal of Thoracic and Cardiovascular Surgery
|March 19, 2017
Summary
Electromagnetic navigational bronchoscopic localization (ENBL) accurately guides minimally invasive surgery for small or deep lung nodules. This technique improves localization success, enabling targeted sublobar resections with high safety and efficacy.
Area of Science:
- Thoracic Surgery
- Pulmonary Medicine
- Interventional Pulmonology
- Surgical Navigation
Background:
- Localizing small or deep pulmonary nodules and subsolid ground-glass opacities is challenging during video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS).
- Difficulty in localization can lead to extended resections or conversion to thoracotomy, increasing patient morbidity.
- Accurate intraoperative localization is crucial for enabling minimally invasive approaches and precise nodule resection.
Purpose of the Study:
- To evaluate the safety and accuracy of electromagnetic navigational bronchoscopic localization (ENBL) as an intraoperative method.
- To assess ENBL's role in localizing small, deep, or subsolid pulmonary nodules prior to resection.
- To determine if ENBL facilitates targeted sublobar resection, thereby improving surgical outcomes.
Main Methods:
- A retrospective study involving 51 patients who underwent combined ENBL and resection of 54 nodules.
- Localization was achieved via intraoperative ENBL-guided transbronchial injection of a liquid marker (methylene blue, indocyanine green, Isovue).
- Patients subsequently underwent VATS for evaluation, followed by RATS for anatomical sublobar resection.
Main Results:
- ENBL successfully localized 53 of 54 nodules (98.1%) for sublobar resection.
- Minimally invasive surgery was successful in 49 of 51 patients (96.1%), with RATS in 47 patients.
- The final diagnoses included adenocarcinoma (59.2%), metastatic disease (13%), and benign lesions (20.3%), with no operative mortalities.
Conclusions:
- Electromagnetic navigational bronchoscopic localization (ENBL) is a safe and accurate intraoperative technique.
- ENBL effectively targets pulmonary nodules that are difficult to localize, facilitating precise sublobar resection.
- The study supports ENBL as a valuable tool for improving outcomes in minimally invasive thoracic surgery for lung nodules.
