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• 12495

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  P3.07 - Poster Session 3 - Surgery (ID 193)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12519

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    P3.07-024 - The endo-finger technique for the localization of small pulmonary ground glass nodules under thoracoscopic surgery (ID 2089)

    09:30 - 09:30  |  Author(s): D. Noma
    • Abstract

    Background
    Small pure ground glass nodules (GGNs) have sometimes been detected by high resolution computed tomography (CT). Pathologically, most of these pure GGNs are bronchioloalveolar carcinoma (BAC) or atypical adenomatous hyperplasia (AAH). In published papers, the thoracoscopic resection of the pure GGNs was reported to be difficult, because they cannot usually be palpated. Therefore, various marking techniques, such as those using a hook wire, colored collagen, barium, lipiodol and so on, have been described for the localization of pure GGNs. However, these techniques are associated with the development of several complications, such as pneumothorax, hemorrhage, and serious air embolism. Moreover, they requires a lot of time. In this study, we evaluated the localization of small pure GGNs in thoracoscopic surgery using the endo-finger technique.

    Methods
    Patients with peripheral pure GGNs that were 20 mm and less in diameter who planned to undergo resection in our institute were candidates for this study. Preoperatively, no marking technique was performed. Thoracoscopy was performed in the lateral position under single lung anesthesia. Thoracoports were placed near the GGNs based on the CT findings. One finger was inserted through the port into the pleural cavity to palpate the lung to localize the GGNs (the endo-finger technique). After the GGNs were detected, they were resected by endostaplers with adequate safety margin.

    Results
    Since January 2005, twenty patients with thirty-four GGNs were enrolled in this study. The size of the GGNs was 5 mm or less in eight lesions, 6 – 10 mm in 14 lesions, 11 – 15 mm in nine lesions and 16 – 20 mm in three lesions. The depth of the lesions from the visceral pleura ranged from 0 – 14 mm. The main reasons for the resection were a need for another ipsilateral simultaneous operation in six cases, the patients’ requests in five cases and enlargement of the GGNs during the follow-up period in three cases. All but one GGN could be detected using the endo-finger technique with two or three thoracoports, and were resected. Some of the GGNs adjacent to the visceral pleura were visualized by thoracoscopy as color changes in the visceral pleura. There was one conversion to thoracotomy in one patient who had a severe pleural adhesion due to a previous ipsilateral lobectomy of the lung. No complications occurred in association with this procedure. The pathological diagnoses of the GGNs were BAC in 23 nodules, AAH in nine, hyperplasia of the alveolar epithelium in one and an inflammatory lesion in one. The surgical margins of all of the resected specimens were pathologically negative.

    Conclusion
    The endo-finger technique is safe and useful for the localization and resection of peripheral GGNs during thoracoscopic surgery. We suggest that the preoperative marking to detect GGNs can be replaced by the endo-finger technique in some cases.