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K. Uyama
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P1.08 - Poster Session with Presenters Present (ID 460)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 2
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.08-037 - Thoracoscopic Segmentectomy of Pulmonary Nodules after Computed Tomography–Assisted Bronchoscopic Metallic Coil Marking (2nd Version) (ID 5603)
14:30 - 14:30 | Author(s): K. Uyama
- Abstract
Background:
With advances in computed tomography (CT), small pulmonary lesions previously unseen on chest radiographs are being increasingly detected. Among lesions less than 10 mm in size, a considerable number of malignancies have been reported. To localize small and deeply situated pulmonary nodules during thoracoscopy with roentgenographic fluoroscopy, we developed a marking procedure that uses a metallic coil and a coin for thoracoscopic segmentectomy.
Methods:
Fifteen patients underwent video-assisted thoracoscopic surgery for removal of 16 pulmonary lesions between January 2011 and January 2016. There were 6 males and 9 females, with an average age of 68.3 years (range 54 to 78 years). Fluoroscopy-assisted thoracoscopic surgery after CT-assisted bronchoscopic metallic coil marking was performed using an ultrathin bronchoscope under bi-plain fluoroscopy viewing a coin on a patient’s chest wall. The coin was simulated a pulmonary lesion by the CT findings, and it was put on the patient's chest wall. During thoracoscopy, a C-arm-shaped roentgenographic fluoroscope was used to detect the radiopaque nodules. The nodule with coil markings was grasped with forceps and resected in segmentectomy under fluoroscopic and thoracoscopic guidance.
Results:
The marking procedure took 11 to 49 minutes from insertion to removal of the bronchoscope. There were no complications from the marking, and all 16 nodules were easily localized by means of thoracoscopy. The metallic coil showed the nodules on the fluoroscopic monitor, which aided in nodule manipulation. Nodules were completely resected under thoracoscopic guidance in segmentectomy. The pathologic diagnosis was primary adenocarcinoma in 10 nodules, pulmonary metastases in 3 nodules, an atypical adenomatous hyperplasia in 1 nodule, a hamartoma in 1 nodule and a nontuberculous mycobacteriosis in 1 nodule. One case of an adenocarcinoma in situ with an extensive two segments was performed a curative segmentectomy.
Conclusion:
In this study, CT-guided transbronchial metallic coil marking with an ultrathin bronchoscope with a coin on a patient’s chest wall under bi-plain fluoroscopy after CT-assisted stimulation was found to be feasible and safe. In our previous report, CT had been needed at least three times, but this method needed only twice CT scan. It might be a useful method not only for making a diagnosis but also for therapeutic resection in selected early lung cancers.
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P1.08-045 - Partial Lung Resection after Bronchoscopic Metallic Coil Marking Using Two Coins and C-Armed Shaped Fluoroscopic Guidance (ID 5837)
14:30 - 14:30 | Author(s): K. Uyama
- Abstract
Background:
The opportunities detecting small pulmonary lesions are increasing because of the spread of CT screening, however, it is sometimes hard to localize the non-palpable tumors located in deep part of the lungs or showing grand- glass opacity lesions. Therefore, it is necessary to mark the location of these tumors before operation. We developed the simple and easy marking technique using two coins and a metallic coil, and examined its reliability, safety, and usefulness.
Methods:
23 patients with 24 small peripheral pulmonary lesions less than 20 mm in size underwent fluoroscopy-assisted thoracoscopic partial lung resection after bronchoscopic metallic coil marking using two coins and C-armed shaped fluoroscopic guidance. The average diameter of the lesions was 10.33mm, and the average distance from the pleural surface was 8.37mm. At first we conducted chest CT scan and confirmed the number of the CT slice in which the tumor exist. Two coins were put on the patient’s chest wall according with the slice number of the antecedent CT scan. A metallic coil was installed in the bronchus near the lesion where the shadows of two coins overlap using ultrathin bronchoscopy under C-armed shaped fluoroscopic guidance. Afterwards, we performed wide wedge resection of the nodules with coil marking under fluoroscopic and thoracoscopic guidance.
Results:
We could install coils in the objective bronchi in all cases. The marking procedure took 13 to 39 minutes from insertion to removal of the bronchoscope. There were no complications from the marking, and all 24 nodules were easily localized at the time of VATS resection. The pathologic diagnosis was primary adenocarcinoma in 9 nodules, pulmonary metastases in 8 nodules, a primary squamous carcinoma in 2 nodules, small cell carcinoma in 2 nodules, an atypical adenomatous hyperplasia in 1 nodule, and a nontuberculous mycobacteriosis in 1 nodule.
Conclusion:
The fluoroscopy-guided coil marking using ultrathin bronchoscope with two coins on a patient’s chest wall after CT-assisted stimulation was a safe, convenient, and reliable method for localization of small pulmonary lesions before VATS partial resection.
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P3.04 - Poster Session with Presenters Present (ID 474)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.04-035 - Pleurodesis with a 50% Glucose Solution for Post-Operative Pneumothorax, after Curative Lung Cancer Resection (ID 5590)
14:30 - 14:30 | Author(s): K. Uyama
- Abstract
Background:
Pleurodesis plays an important role in the management of pneumothorax, especially among patients who underwent curative lung cancer resection. Previous papers reported the efficacy of pleurodesis with OK-432, talc, or other cytotoxic ageents, but these agents sometimes trigger lethal complications. Recently, several institutions reported 50% glucose solution as pleurodesis for pneumothorax. And we adopt it for post-operative pneumothorax patients. We report the feasibility of pleurodesis with 50% glucose solution for post-operative pneumothorax, after curative lung cancer resection.
Methods:
From October 2014 to March 2016, 13 cases of post-operative pneumothorax after curative lung cancer resection were treated in our hospital. They were treated with pleurodesis with a 50% glucose solution. 200 mL of a 50% glucose solution with 10 mL of 1% lidocaine was instilled into the pleural cavity. Patients regularly change their positions for 2 hours, due to immerse whole visceral pleura. Pleurodesis was repeated until the air leakage stopped.
Results:
The subjects were 10 men and 3 women, with a mean age of 71 years. 9 patients were past or current smokers. All cases underwent video-assisted-thoracic-surgery (VATS) lobectomy, and Right upper/middle/lower/Left upper/lower lobe resections were 5/2/3/2/1 cases each. Air leakage stopped after pleurodesis in all cases, and 2 cases required pleurodesis twice. No patient required re-operation, and was suffered from high fever, chest pain, or other complications. Drain tube was removed in 2.9 days after pleurodesis on average, and there was no post-treatment recurrence.
Conclusion:
These results demonstrated feasibility of pleurodesis with a 50% glucose solution for post-operative pneumothorax, after curative lung cancer resection. This procedure can be the first choice for post-operative pneumothorax treatment.
