Related Experiment Video
Updated: Aug 28, 2025
Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery
Published on: May 4, 2022
Efficacy and safety of intraoperative cone-beam CT-guided localization of small pulmonary nodules
Taisuke Kaiho1, Hidemi Suzuki1, Atsushi Hata1
1Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Objectives:
This study aimed to evaluate the efficacy and safety of intraoperative cone-beam computed tomography-guided video-assisted thoracoscopic surgery wedge resection of impalpable small pulmonary nodules.
Methods:
This was a single-centre phase 2 trial conducted between April 2018 and March 2019. Peripheral small pulmonary nodules, defined as either ground-glass opacity-dominant (>50%) nodules measuring ≤3 cm in diameter (ground-glass opacity-dominant type) or nodules measuring ≤2 cm in diameter located deeper than the nodule diameter from the visceral pleura (deep solid type), were eligible for resection using a cone-beam computed tomography-guided thoracoscopic manner. The primary end-point was macroscopic complete resection, and secondary end-points were: nodule extraction rate, operation time, localization time, marking accuracy, microscopic complete resection and safety.
Results:
Twenty-two nodules, in 9 men and 11 women with a mean age of 64.3 years, were visualized and resected. The nodules were located in the right upper, middle and lower lobes in 3, 1 and 5 patients, respectively, and in the left upper and lower lobes in 5 and 8 patients, respectively. Seven nodules were ground-glass opacity-dominant types, and 15 were deep solid types. Cone-beam computed tomography could clearly image all nodules. The mean time for localization was 17.4 min. The mean operation time was 110.7 min. Macroscopic complete resection was accomplished in 21 nodules (95.5%). Microscopic complete resection was achieved in all nodules (100%). Postoperative air leakage and bleeding were observed in 1 patient (5%).
Conclusions:
Cone-beam computed tomography might be a safe and useful guide for video-assisted thoracoscopic surgery wedge resection of impalpable peripheral pulmonary nodules.
Date And Number Of Irb Approval:
15 November 2017, 381.
Clinical Trial Registration Number:
UMIN 000030388.
Insights
Intraoperative cone-beam computed tomography (CBCT) guided video-assisted thoracoscopic surgery (VATS) offers a safe and effective method for resecting impalpable small pulmonary nodules. This technique achieved high rates of complete resection with minimal complications.
Area of Science:
- Thoracic Surgery
- Medical Imaging
- Pulmonology
Background:
- Small pulmonary nodules, especially impalpable ones, pose challenges for accurate localization and resection.
- Video-assisted thoracoscopic surgery (VATS) has advanced minimally invasive thoracic procedures.
- Intraoperative imaging guidance is crucial for improving the precision of VATS in complex cases.
Purpose of the Study:
- To evaluate the efficacy and safety of using intraoperative cone-beam computed tomography (CBCT) for guiding video-assisted thoracoscopic surgery (VATS) wedge resection of impalpable small pulmonary nodules.
- To assess the feasibility of CBCT in localizing and resecting peripheral pulmonary nodules.
- To determine the success rates of macroscopic and microscopic complete resection and evaluate safety outcomes.
Main Methods:
- A single-center phase 2 trial was conducted involving patients with peripheral small pulmonary nodules eligible for CBCT-guided VATS resection.
- Nodule types included ground-glass opacity-dominant and deep solid types.
- Key endpoints measured were macroscopic and microscopic complete resection rates, operation time, localization time, marking accuracy, and safety.
Main Results:
- Twenty-two nodules were successfully visualized and resected in 20 patients.
- Cone-beam computed tomography (CBCT) accurately imaged all nodules, with a mean localization time of 17.4 minutes.
- Macroscopic complete resection was achieved in 95.5% of cases, and microscopic complete resection in 100%. Postoperative complications were minimal (5%).
Conclusions:
- Intraoperative cone-beam computed tomography (CBCT) serves as a safe and effective guidance tool for video-assisted thoracoscopic surgery (VATS) wedge resection of impalpable peripheral pulmonary nodules.
- The technique demonstrates high precision in localization and resection, contributing to excellent oncological outcomes.
- CBCT-guided VATS represents a valuable advancement in the surgical management of small, difficult-to-localize lung lesions.
