P1.08-037 Thoracoscopic Segmentectomy of Pulmonary Nodules after Computed Tomography–Assisted Bronchoscopic Metallic Coil Marking (2nd Version)

Abstract

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. 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. 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. 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.