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Author Spotlight: Expanding Interventional Pulmonology Research with Robotic-Assisted Bronchoscopy
Published on: July 19, 2024
Enhancing Microwave Ablation for Lung Lesions with Cone-Beam Computed Tomography Guidance and Intrapulmonary Fine
Ling-Kai Chang1, Po-Keng Su2, Shwetambara Malwade3
1Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan (L.K.C., P.K.S., W.Y.C., P.S.C., L.C.C., S.M.Y.); Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan (L.K.C., L.C.C.); Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan (L.K.C.).
Rationale And Objectives:
To review outcomes of the first 150 consecutive microwave ablation (MWA) cases at our institution to assess the safety and diagnostic performance of a new workflow for cone-beam computed tomography (CBCT)-guided percutaneous MWA performed under general anesthesia in a hybrid operating room (HOR).
Materials And Methods:
This retrospective study included 150 consecutive patients who underwent MWA in the CBCT-equipped HOR between July 2020 and January 2024. The procedural workflow involved general anesthesia with patient fixation, CBCT scanning, iGuide needle pathway planning, needle placement with a laser beam and augmented fluoroscopy guidance, and post-procedure ablation-zone assessment. Technical advancements included the use of a coaxial needle for synchronous biopsy and ablation and a fine adjustment tool.
Results:
In total, 145 lesions in 127 patients (82 women and 45 men; mean age, 59.8±13.1years [standard deviation]; single nodule, 113 patients; multiple nodules, 14 patients) were analyzed. The median global operating-room time, procedure time, total dose area product, and postoperative stay were 110 min, 45 min, 19,701 μGym², and 2 days, respectively. CBCT-guided MWA improved diagnostic yield for subcentimeter lung lesions to 50.0% with intra-parenchymal fine adjustment, compared to 10.1% without. Pneumothorax rates decreased significantly to 6% with coaxial needles for biopsy and ablation, compared to 12.1% with prior methods. Post-procedure complications were mostly tolerable, with two fatal complications occurring in the early cohort.
Conclusion:
The MWA technique is safe and feasible, with various technical strategies enhancing its efficacy. The intra-parenchymal fine adjustment method significantly improves small-nodule biopsy yield.
