Author of

• 20165

  +

  P1.16 - Surgery (ID 702)

  • Event: WCLC 2017
  • Type: Poster Session with Presenters Present
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)

  • 22828

    +

    P1.16-026 - Multimodal Image-Guided VATS Resection of Sub-Centimeter Pulmonary Nodules by Cone Beam CT and Bronchoscopic NIR Fluorescence Marking (ID 9222)

    09:30 - 09:30  |  Author(s): H. Okada
    • Abstract

    Background:
    Small-sized pulmonary nodules such as ground grass nodule and metastatic nodules are difficult to identify the localization during video-assisted thoracic surgery (VATS). The authors have developed the bronchoscopic indocyanine green fluorescence (ICG-FL) marking of small-sized pulmonary nodules to localize them durging VATS. The ICG-FL marking have some advantages. Near infra-red (NIR) light has excellent tissue penetrating property so that the ICG-FL marked in the lung parenchyma can be detected from the surface of lung with ICG-FL detecting thoracoscope. Also, NIR fluorescence spectrum can be isolated from the visible color spectrum so that ICG-FL can be detected with high sensitivity regardless of the color tone of the background lung. In the current study, taking advantage of the hybrid operating room (Hybrid OR), all procedures such as navigation bronchoscopic injection of ICG, real-time image-guidance by cone beam CT, intraoperative detection of ICG-FL and VATS wedge resection were performed all at one time under general anesthesia. The purpose of the current study was the validation of the presenting procedure in terms of the accuracy of localization, the surgical invasiveness, and operation time.
    
    Method:
    The patients with sub-centimeter pulmonary nodules which were diagnosed as the indication of video-assisted wedge pulmonary resection were enrolled in the study (n=5). At Hybrid OR under general anesthesia, thin bronchoscope was inserted into the peripheral bronchus which lead to the pulmonary nodule. Virtual bronchoscopy navigation was utilized to increase the accuracy of bronchoscopy. Transbronchial aspiration cytology (TBAC) needle was inserted to peripheral bronchus adjucent to the pulmonary nodule. After confirming the location of TBAC needle by Cone beam CT, the 0.05mL of 0.025mg/mL of ICG mixed with iopamidol was injected into lung parenchyma. During VATS resection, the infra-red fluorescence spot of ICG adjucent to the pulmonary nodules were visualized by ICG-FL thoracoscopy (Pin-point, Novadaq. Canada). The successful pulmonary resection was confirmed with macro- and microscopic examination during surgery.
    
    Result:
    ICG-FL marking was successful in all 5 cases 8 lesions without any complication. All tumors were successfully excised with the sufficient surgical safety margin. No adverse events were experienced throughout the entire study.
    
    Conclusion:
    Cone-beam CT in Hybrid OR can increase the accuracy of bronchoscopic ICG-FL marking. Multimodal cone-beam CT-guided bronchoscopic ICG-FL marking is a precise method to excise the multiple, small-sized pulmonary noddules by minimally invasive thoracic surgery.