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Peripheral lung nodules: fluoroscopically guided video-assisted thoracoscopic resection after computed tomography-guided localization using platinum microcoils.
Ann Surg. 2004 Sep; 240(3):481-8; discussion 488-9.AnnS

Abstract

OBJECTIVES

We sought to test the safety and efficacy of fluoroscopically guided, video-assisted, thoracoscopic resection after computed tomography (CT)-guided localization using platinum microcoils.

SUMMARY BACKGROUND DATA

Video-assisted thoracoscopic (VATS) resection of small pulmonary nodules >5 mm deep to the visceral pleura fails to locate the nodule and requires conversion to open thoracotomy in two thirds of cases. Therefore, we developed a new technique for intraoperative localization of these nodules using CT-guided placement of platinum microcoils. This study tests the safety and efficacy of this technique in a Phase I human study.

METHODS

Twelve patients with undiagnosed growing pulmonary nodules <20 mm were marked preoperatively using percutaneously placed CT-guided platinum microcoils. The coil was deployed adjacent to the nodule with the distal end of the coil placed deep to the nodule and the superficial end coiled on the pleural surface. The nodule and coil were excised using endostaplers guided by VATS and fluoroscopy. Histopathologic diagnosis was performed immediately after resection.

RESULTS

CT-guided microcoil localization was successful in all patients. A small hemothorax and a pneumothorax requiring a chest tube occurred in 2 patients. Mean distance from visceral pleura to the deep edge of the nodule was 30.9 +/- 15.4 mm. VATS resection of the nodules (size = 11.8 +/- 3.2 mm) was successful in all patients. Mean microcoil localization, fluoroscopy, and operative times were 42 +/- 14, 3.1 +/- 2.0, and 67 +/- 27 minutes. A diagnosis of primary nonsmall cell bronchogenic carcinoma was made in 6 patients who then received a completion lobectomy. Six patients (hamartoma: 2, reactive lymph node: 1, bronchoalveolar cell carcinoma: 2, metastatic sarcoma: 1) did not receive further resections.

CONCLUSIONS

Preoperative localization of pulmonary nodules using percutaneous CT-guided platinum microcoil insertion combined with operative fluoroscopic visualization is a safe, effective technique that increases the success rate of VATS excision.

Authors+Show Affiliations

Department of Surgery, Vancouver Hospital and Health Sciences Centre University of British Columbia, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Clinical Trial, Phase I
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15319719

Citation

Powell, Tom I., et al. "Peripheral Lung Nodules: Fluoroscopically Guided Video-assisted Thoracoscopic Resection After Computed Tomography-guided Localization Using Platinum Microcoils." Annals of Surgery, vol. 240, no. 3, 2004, pp. 481-8; discussion 488-9.
Powell TI, Jangra D, Clifton JC, et al. Peripheral lung nodules: fluoroscopically guided video-assisted thoracoscopic resection after computed tomography-guided localization using platinum microcoils. Ann Surg. 2004;240(3):481-8; discussion 488-9.
Powell, T. I., Jangra, D., Clifton, J. C., Lara-Guerra, H., Church, N., English, J., Evans, K., Yee, J., Coxson, H., Mayo, J. R., & Finley, R. J. (2004). Peripheral lung nodules: fluoroscopically guided video-assisted thoracoscopic resection after computed tomography-guided localization using platinum microcoils. Annals of Surgery, 240(3), 481-8; discussion 488-9.
Powell TI, et al. Peripheral Lung Nodules: Fluoroscopically Guided Video-assisted Thoracoscopic Resection After Computed Tomography-guided Localization Using Platinum Microcoils. Ann Surg. 2004;240(3):481-8; discussion 488-9. PubMed PMID: 15319719.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Peripheral lung nodules: fluoroscopically guided video-assisted thoracoscopic resection after computed tomography-guided localization using platinum microcoils. AU - Powell,Tom I, AU - Jangra,Dalbhir, AU - Clifton,Joanne C, AU - Lara-Guerra,Humberto, AU - Church,Neal, AU - English,John, AU - Evans,Ken, AU - Yee,John, AU - Coxson,Harvey, AU - Mayo,John R, AU - Finley,Richard J, PY - 2004/8/21/pubmed PY - 2004/9/21/medline PY - 2004/8/21/entrez SP - 481-8; discussion 488-9 JF - Annals of surgery JO - Ann. Surg. VL - 240 IS - 3 N2 - OBJECTIVES: We sought to test the safety and efficacy of fluoroscopically guided, video-assisted, thoracoscopic resection after computed tomography (CT)-guided localization using platinum microcoils. SUMMARY BACKGROUND DATA: Video-assisted thoracoscopic (VATS) resection of small pulmonary nodules >5 mm deep to the visceral pleura fails to locate the nodule and requires conversion to open thoracotomy in two thirds of cases. Therefore, we developed a new technique for intraoperative localization of these nodules using CT-guided placement of platinum microcoils. This study tests the safety and efficacy of this technique in a Phase I human study. METHODS: Twelve patients with undiagnosed growing pulmonary nodules <20 mm were marked preoperatively using percutaneously placed CT-guided platinum microcoils. The coil was deployed adjacent to the nodule with the distal end of the coil placed deep to the nodule and the superficial end coiled on the pleural surface. The nodule and coil were excised using endostaplers guided by VATS and fluoroscopy. Histopathologic diagnosis was performed immediately after resection. RESULTS: CT-guided microcoil localization was successful in all patients. A small hemothorax and a pneumothorax requiring a chest tube occurred in 2 patients. Mean distance from visceral pleura to the deep edge of the nodule was 30.9 +/- 15.4 mm. VATS resection of the nodules (size = 11.8 +/- 3.2 mm) was successful in all patients. Mean microcoil localization, fluoroscopy, and operative times were 42 +/- 14, 3.1 +/- 2.0, and 67 +/- 27 minutes. A diagnosis of primary nonsmall cell bronchogenic carcinoma was made in 6 patients who then received a completion lobectomy. Six patients (hamartoma: 2, reactive lymph node: 1, bronchoalveolar cell carcinoma: 2, metastatic sarcoma: 1) did not receive further resections. CONCLUSIONS: Preoperative localization of pulmonary nodules using percutaneous CT-guided platinum microcoil insertion combined with operative fluoroscopic visualization is a safe, effective technique that increases the success rate of VATS excision. SN - 0003-4932 UR - https://www.unboundmedicine.com/medline/citation/15319719/Peripheral_lung_nodules:_fluoroscopically_guided_video_assisted_thoracoscopic_resection_after_computed_tomography_guided_localization_using_platinum_microcoils_ L2 - http://Insights.ovid.com/pubmed?pmid=15319719 DB - PRIME DP - Unbound Medicine ER -