Video-assisted Thoracoscopic Surgery Resection Research Articles

Use of a novel claw-suture technique for localization of solitary pulmonary nodules: retrospective study and experience from one center.

Video-assisted thoracoscopic surgery (VATS) is more effective for diagnosing and treating solitary pulmonary nodules (SPNs). It is sometimes difficult to localize through use of minimally invasive techniques. We evaluated the feasibility, effectiveness, and safety of a novel localization method for SPNs. Here, we describe our technical process, perioperative results, and accumulated experience over the years. Between February 2018 and April 2023, a retrospective study of a novel claw-suture localization technique was conducted in a single center. A total of 490 patients participating in the localization of preoperative SPNs were enrolled. An anchor claw device with four hooks and three-colored sutures was used for localizing nodules under computed tomography (CT). We then evaluated the localization process and the outcomes of the operative procedure (success rate, safety, feasibility, and patient comfort). A total of 510 SPNs were localized before surgery, and the median size of the nodules was 0.70 cm (range, 0.4-2.0 cm). Additionally, 97.1% of these nodules (495 of 510) were localized successfully without dislodgment or device fracture. Types of failures included not meeting the target value of the distance between the claw and lesion (n=12, 2.4%) and displacement of the device (n=3, 0.6%). Pneumothorax (n=63, 12.4%), parenchymal hemorrhage (n=46, 9.0%), and hemothorax (n=1, 0.2%) were the most common complications that did not require further medical treatment. Pleural reactions were reported in 2 patients (0.4%). A notable correlation was also found between the depth of the pulmonary nodules and the incidence of parenchymal hemorrhage (P<0.001). The median length for the entire process was 12 minutes (7-25 minutes). No patients reported significant pain during the localization process, and the device was retrieved with a 100% survival rate after VATS resection. This method of claw-suture localization is safe, effective, and feasible and can be used to localize SPNs that are challenging to locate before operation.

Indocyanine green localization for preoperative CT-guided localization of multiple pulmonary nodules.

This study assesses the safety and efficacy of using indocyanine green (ICG) for preoperative CT-guided localization of multiple pulmonary nodules. We included patients who underwent CT-guided preoperative ICG localization followed by video-assisted thoracoscopic surgery (VATS). Four primary outcomes were evaluated: technical success, pneumothorax, pulmonary hemorrhage, and postoperative hospital stay (PHS). Patients were classified into single nodule and multiple nodules groups, with further subgroups based on the side of localization including unilateral and bilateral subgroups. Univariate and multivariate analyses were used to evaluate risk factors for PHS and pneumothorax. A total of 374 patients (54.8 ± 11.4 years, 99 with multiple nodules). The success rate in the multiple nodules group was 98.3%, similar to single nodules. Apart from PHS, no significant differences were observed in outcomes between patients with single and multiple nodules. Longer PHS was observed for patients with multiple nodules (3 [2-4] days vs. 3 [3-4] days, p = 0.022). Multivariable analysis indicated longer stays were associated with pulmonary hemorrhage during localization, surgical blood loss, postoperative complications, and non-segmentectomy procedures. Advanced age emerged as the sole independent risk factor for pneumothorax. The success rate in the unilateral subgroup and the bilateral subgroup was 97.8% and 99%, respectively, with higher pneumothorax rates in the unilateral subgroup (38.3% vs. 20%). CT-guided preoperative ICG localization of multiple pulmonary nodules is safe and effective. It can be applied to both unilateral and bilateral nodules, supporting simultaneous VATS resection.

Ten-year survival outcomes of video-assisted thoracic surgery vs. open major lung resection for stage I-III non-small cell lung cancer: a large cohort study in China.

Despite the widespread adoption of video-assisted thoracoscopic surgery (VATS) for major lung resection, the 10-year long-term survival outcomes of non-small cell lung cancer (NSCLC) treated with VATS compared with open major lung resection is lacking. The purpose of this study was to analyze the short- and long-term outcomes of VATS vs. open major lung resection for NSCLC. The perioperative outcomes and long-term survival of p-stage I-III NSCLC patients who underwent major lung resection via VATS vs. open major lung resection in the Western China Lung Cancer Database (WCLCD) between May 2006 and June 2018 were studied using propensity score matching (PSM). Of the 10,167 patients who underwent surgery for lung malignancies, 6,405 patients with stage I-III NSCLC were included in the study, including 4,224 in the VATS group and 2,181 in the open group. PSM resulted in 1,487 patients in both the VATS and open groups. The patients were matched by patient demographics, Charlson comorbidity index (CCI), tumor histology and TNM stage. Compared with open surgery, major lung resection via VATS resulted in less blood loss (median: 50 vs. 100 mL, P<0.001) and a shorter postoperative hospital stay (7.6±6.0 vs. 8.6±4.9 days, P<0.001) but higher total hospital costs (52.5±21.2 vs. 45.0±16.4 kRMB, P<0.001). The matched cohort showed that patients who underwent major lung resection via VATS had better overall survival (OS) and recurrence-free survival (RFS) than did patients who underwent major lung resection via open surgery (5-year survival: 64.9% vs. 57.7%, P<0.001; 5-year RFS: 50.3% vs. 45.3%, P=0.003). Patients who underwent VATS had a better 10-year OS rate (47.8% vs. 42.6%). According to the subgroup analysis, patients with stage II NSCLC who underwent major lung resection via VATS had better OS and RFS (OS: P<0.001; RFS: P=0.004), while there were no significant differences in OS or RFS between stage I and III NSCLC patients. Major lung resection via the VATS should be the preferred surgical option for stage I-III NSCLC patients due to its superior long-term survival outcome and advantages of less blood loss and shorter postoperative hospital stays.

Analysis of complication risk factors in preoperative computed tomography-guided hookwire location of pulmonary nodules

BackgroundThis study aimed to explore the efficacy of hookwire for computed tomography (CT)-guided pulmonary nodule (PN) localization before video-assisted thoracoscopic surgery (VATS) resection and determine the risk factors for localization-related complications.MethodsWe enrolled 193 patients who underwent preoperative CT-guided PN hookwire localization. The patients were categorized into groups A (103 patients had no complications) and B (90 patients had complications) according to CT and VATS. Uni- and multivariate logistic regression analyses were used to identify risk factors for localization-related complications. A numerical rating scale was used to evaluate hookwire localization-induced pain.ResultsWe successfully performed localization in 173 (89.6%) patients. Pneumothorax was the main complication in 82 patients (42.5%). Patient gender, age, body mass index, tumor diameter, consolidation tumor ratio, pathologic diagnosis, position adjustment during location, lesion location, waiting time for surgery, and pleural adhesions were not significantly different between the two groups. The number of nodules, number of punctures, scapular rest position, and depth of insertion within the lung parenchyma were significant factors for successful localization. Multivariate regression analysis further validated the number of nodules, scapular rest position, and depth of insertion within the lung parenchyma as risk factors for hookwire-localization-related complications. Hookwire localization-induced pain is mainly mild or moderate pre- and postoperatively, and some patients still experience pain 7 days postoperatively.ConclusionsHookwire preoperative PN localization has a high success rate, but some complications remain. Thus, clinicians should be vigilant and look forward to further improvement.

Pulmonary presentation and coil marcation of dirofilaria lung coin nodes - case report.

Clinicians face significant diagnostic challenges when dealing with nodal lesions of the lung. The majority of lung nodules are benign; however, asignificant number can be cancerous. Dirofilaria infestation should also be considered in the differential diagnosis of nodal lung lesions. Most patients with Dirofilaria infestation are asymptomatic. To determine the etiology of nodal lung infiltrations, procedures like radiological imaging, bronchoscopy, endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA), transthoracic biopsy (TTB), tumor markers, nonspecific serological tests, or surgical removal of the lung coin lesions can be performed. Coil marking of the smaller lung lesions under computed tomography (CT) guidance is ahelpful tool in determining the position and localization of the nodal lung lesions. Video-assisted thoracoscopic surgery (VATS) or robot-assisted thoracoscopic surgery (RATS) wedge resection is adiagnostic and therapeutic method of choice. No additional treatment of Dirofilaria other than wedge resection of the lung is necessary.

Subpleural pulmonary nodule marking with patent blue V dye prior to surgical resection.

Subpleural located pulmonary nodules are perioperatively invisible to the surgeon. Their precise identification is conventionally possible by palpation, but often at the cost of performing a thoracotomy. The aim of the study was to evaluate the success rate and feasibility of the pre-operative CT-guided marking subpleural localized nodule using a mixture of Patent Blue V and an iodine contrast agent prior to the extra-anatomical video-assisted thoracoscopic surgery (VATS) resection in patients for whom the primary anatomical resection in terms of segmentectomy or lobectomy was not indicated. The data of consecutive patients with pulmonary nodules located ≤ 30 mm from the parietal pleura, who were indicated for VATS extra-anatomical resection between 2017 to 2023, were retrospectively reviewed and analyzed. All patients indicated for VATS resection underwent color marking of the area with the pulmonary lesion under CT-guided control immediately before the surgery. The primary outcome was the marking success. Morphological lesion characteristics, time from marking to the surgery, procedure related complications, final histology findings and 30day mortality were analyzed. Additionally, we assessed the association of the successful marking and the patient's smoking history. A total of 62 lesions were marked. The successful marking was observed in 56/62 (90.3%) patients. The median time from the lesion marking to the beginning of surgery was 75.0 (IQR 65.0-85.0) minutes. The procedure related pneumothorax was observed in 6 (9.7%) patients, intraparenchymal hematoma in 1 (1.6%) patient. No statistically significant association of the depth of the subpleural lesion's location, occurrence of complications or time from the marking to surgery and the successful marking was observed. The 30day mortality was zero. No association of smoking and successful marking was observed. The method of marking the subpleural pulmonary lesions under CT-guided control with a mixture of Patent Blue V and iodine contrast agent is a safe and effective method with minimal complications. It provides surgeons the precise visualization of the affected pulmonary parenchyma before the planned extra-anatomical VATS resection.

Intercostal Catheters Reduce Long-Term Pain and Postoperative Opioid Consumption after VATS.

Background/Objectives: Pain after video-assisted thoracoscopic surgery (VATS) leads to impaired postoperative recovery, possible side effects of opioid usage, and higher rates of chronic post-surgery pain (CPSP). Nevertheless, guidelines on perioperative pain management for VATS patients are lacking. The aim of this study was to analyze the effectiveness of intercostal catheters in combination with a single shot intraoperative intercostal nerve block (SSINB) in comparison to SSINB alone with respect to opioid consumption and CPSP. Methods: Patients receiving an anatomic VATS resection between 2019 and 2022 for primary lung cancer were retrospectively analyzed. A total of 75 consecutive patients receiving an ICC and SSINB and 75 consecutive patients receiving only SSINB were included in our database. After enforcing the exclusion criteria (insufficient documentation, external follow-ups, or patients receiving opioids on a fixed schedule; n = 9) 141 patients remained for further analysis. Results: The ICC and No ICC cohort were comparable in age, gender distribution, tumor location and hospital stay. Patients in the ICC cohort showed significantly less opioid usage regarding the extent (4.48 ± 6.69 SD vs. 7.23 ± 7.55 SD mg, p = 0.023), duration (0.76 ± 0.97 SD vs. 1.26 ± 1.33 SD days, p = 0.012) and frequency (0.90 ± 1.34 SD vs. 1.45 ± 1.51 SD times, p = 0.023) in comparison to the No ICC group. During the first nine months of oncological follow-up assessments, no statistical difference was found in the rate of patients experiencing postoperative pain, although a trend towards less pain in the ICC cohort was found. One year after surgery, the ICC cohort expressed significantly less often pain (1.5 vs. 10.8%, p = 0.035). Conclusions: Placement of an ICC provides VATS patients with improved postoperative pain relief resulting in a reduced frequency of required opioid administration, less days with opioids, and a reduced total amount of opioids consumed. Furthermore, ICC patients have significantly lower rates of CPSP one year after surgery.

Factors Associated With Margin Positivity After Lung Resection Surgery

IntroductionThe purpose of this study is to utilize a representative national sample to investigate the factors associated with margin positivity after attempted surgical resection. Given the changes in surgical approaches to lung cancer for the last 10 years, margin positivity and outcomes between robotic, video assisted thoracoscopic surgery (VATS) and open surgical resections may vary. MethodsThis retrospective cohort study utilized the National Cancer Database. Patients with non–small-cell lung cancer, 18 or older and who had a surgical lung resection between 2010 and 2019 were included. Demographic data, along with patient-level clinical variables were extracted. Patient-level outcome variables including 30-day, 90-day mortality and readmission rates were analyzed. Univariable and multivariable logistic regression was utilized to assess factors associated with margin positivity. ResultsA total of 226,884 patients were identified. Of the total cohort, 9229 had positive margins (4.2%). Patients with positive margins had statistically significant increased 30-day, 90-day mortality, as well as increased readmission rate. Older age, male sex, patients undergoing an open resection, patients who underwent a wedge resection, higher clinical stage, larger tumor size, squamous and adenosquamous histologies, and higher Charlson-Deyo Comorbidity Index were all associated with having a positive margin after resection. ConclusionIn conclusion, there was no difference in margin positivity when comparing robotic and VATS resection, however, open resection had increased rates of margin positivity. Increasing tumor size, clinical stage, squamous and adenosquamous histologies, male sex, and patients undergoing a wedge resection were all associated with increased rates of margin positivity.

Outcomes of robot-assisted versus video-assisted mediastinal mass resection during the initial learning curve

To compare the learning curve of mediastinal mass resection between robot-assisted surgery and thoracoscopic surgery. Retrospective perioperative data were collected from 160 mediastinal mass resection cases. Data included 80 initial consecutive video-assisted thoracoscopic surgery (VATS) resection cases performed from February 2018 to February 2020 and 80 initial consecutive robotic-assisted thoracic surgery (RATS) resection cases performed from March 2020 to March 2023. All cases were operated on by a thoracic surgeon. The clinical characteristics and perioperative outcomes of the two groups were compared. The operation time in both the RATS group and VATS group was analyzed using the cumulative sum (CUSUM) method. Based on this method, the learning curves of both groups were divided into a learning period and mastery period. The VATS group and the RATS group crossed the inflection point in the 27th and 21st case, respectively. Subsequently, we found that the learning period was longer than the mastery period with statistically significant differences in terms of the operating time, and postoperative hospital stay in the VATS group and the RATS group. A certain amount of VATS experience can shorten the learning curve for RATS.

Radiological Features of Changes in the Lungs Caused by Fast- or Slow-Growing Nontuberculous Mycobacteria

Objective: to compare radiological features of pulmonary nontuberculous mycobacterioses (NTM) caused by fast- or slow-growing mycobacteria.Material and methods. Radiological features of the disease were studied in 110 patients with newly diagnosed NTM. The patients were divided into two groups: 70 (63.6%) patients with slow-growing NTM and 40 (36.3%) with fast-growing NTM. The diagnosis was based on patient’s complaints, specified case history, radiological studies, clinical laboratory studies, sputum smear studies, bronchoalveolar lavage studies, different types of bronchial biopsies, and video-assisted thoracoscopic surgery resection samples. According to the results of high-resolution computed tomography (HRCT), a comparative analysis of the degree of involvement in the pathological process of such anatomical formations as parenchyma and stroma, vessels, bronchi, pleura and intrathoracic lymph nodes was carried out.Results. The analysis of HRCT studies showed that fast-growing NTM is not characterized by gross deformation of bronchopulmonary structures. There is a more pronounced infiltrative phase with the involvement of vessels, pleura and bronchial lesions of smaller generations, the formation of broncho-bronchiolectasias and symptoms of bronchiolitis, faster clinical and radiological involution under dynamic observation. Slow-growing NTM is characterized by a more severe deformation of bronchopulmonary structures with the formation of different-sized bronchiectasis, bronchogenic cavities, a more torpid course of the inflammatory process.Conclusion. Despite the similarities of clinical and radiological patterns of NTM, we established some distinguished features for slow-growing and fast-growing types.

A novel preoperative image-guided localization for small pulmonary nodule resection using a claw-suture device

Video-assisted thoracoscopic surgery (VATS) provides better option concerning pathological diagnosis and curative intention of small pulmonary nodules (SPNs) that are sometimes challenging to localize. We assess the safety and feasibility of a new localization technique for SPNs, and report experience accumulated over time. A retrospective review of the new claw-suture localization cases between February 2018 and May 2023 was performed. Nodules were localized by a novel system that has an anchor claw and a tri-colored suture, guided by computed tomography (CT). Localization and operative procedure outcomes were then assessed. A total of 590 SPNs were localized from 568 patients before operation. The median nodule size was 0.70 cm (range, 0.3–2.0 cm). The claw-suture localization was successful without dislodgment or device fracture in 574 of 590 lesions (97.3%). Failures included not meeting target distance between claw and lesion (n = 13 [2.2%]), and device displacement (n = 3 [0.5%]). Complications requiring no further medical intervention included asymptomatic pneumothorax (n = 68 [11.5%]), parenchymal hemorrhage (n = 51 [8.6%]), and hemothorax (n = 1 [0.2%]) with the exception of pleural reaction observed in 2 cases (0.3%). Additionally, the depth of pulmonary nodules was significantly associated with the occurrence of pneumothorax (P = 0.036) and parenchymal hemorrhage (P = 0.000). The median duration of the localization was 12 min (range, 7–25 min). No patient complained of remarkable pain during the entire procedure. Retrieve of device after operation was 100%. The new localization technique is a safe, feasible, and well-tolerated method to localize SPNs for VATS resection.

Video-Assisted Thoracoscopic Surgery (VATS) in the Treatment of Pulmonary Bulla

Introduction: Video-assisted thoracoscopic surgery (VATS) has been widely applied for the treatment of intrathoracic diseases, including bullous lung disease. VATS has been evaluated to replace thoracotomy for various lung resection surgeries. This study aims to determine the efficacy, safety, and outcome VATS for bullectomy. Method: This retrospective study was performed from January 2021 to December 2022 in the department of Thoracic Surgery at National Institute of Diseases of the Chest &amp; Hospital, Dhaka and Green Life Hospital, Dhaka. We reviewed all the patients who underwent bullectomy through VATS within this period. The demographic and operative variables were collected. The safety and efficacy of the procedure in terms of postoperative complications and change in lung function after bullectomy was analysed. Result: Forty patients underwent elective VATS bullectomy due either to giant bulla or pneumothorax. Among them, 36 were male with mean age 47.4 years (range 20-65 years). There was significant improvement in lung function following bullectomy. Approximately one third patients (32.5%) developed postoperative complications, majority having air leak. There was no postoperative mortality within 30 days. Conclusion: VATS resection is a safe and effective treatment for bullous lung disease with significant improvement in symptoms and lung function following surgery. J Bangladesh Coll Phys Surg 2023; 41(4): 287-293

A novel, simple near-infrared thoracoscopic technique by a particular route for locating lung nodules.

The localization of pulmonary nodules prior to thoracoscopic surgery remains challenging for thoracic surgeons, especially for those nodules that are not visible or palpable on the lung surface. Our study is a simple and effective minimally invasive method using indocyanine green through a special pathway to locate pulmonary nodules and fluorescence thoracoscopic surgery. Thoracoscopic surgery was performed for 18 undiagnosed peripheral non-solid nodules no larger than 2 cm after location. After 0.3 mg/kg indocyanine green was injected through the peripheral vein, the puncture needle was pulled out after it reached approximately 1 cm of the pulmonary parenchyma near the nodules. This was followed by transfer to the operating room. The nodule was initially localized by using a near-infrared thoracoscope to visualize indocyanine green fluorescence. Then, thoracoscopic resection was performed. Eighteen patients received this special and simple localization method, and underwent near-infrared, image-guided, video-assisted thoracoscopic surgery resection. Median computed tomography (CT) tumor size was 1.2 cm. Median depth from the pleural surface is 1.6 cm (range, 0.1-4.6 cm). The median time of CT-guided intervention was 12 min. The duration of thoracoscopic surgery was 67 min. Indocyanine green fluorescence was clearly identified in 17 of 18 patients (94.4%). The surgical margins were all negative on final pathology. The final diagnoses included 17 primary lung cancers, and 1 benign lung tumor. CT-guided single puncture of indocyanine green after peripheral intravenous injection is a simple, effective, and safe method to locate the nodule. This offers surgeons the ease of localization through direct indocyanine green fluorescence imaging, and it can be used as an effective alternative to other placement methods of locating pulmonary nodules.

CT-guided microcoil localization of pulmonary nodules before VATS: clinical experience in 1059 patients.

To retrospectively evaluate the efficacy and safety of CT-guided microcoil localization of pulmonary nodules before video-assisted thoracoscopic surgery (VATS). A total of 1059 consecutive patients with 1331 pulmonary nodules treated between July 2018 and April 2021 were included in this study. Of the 1331 nodules, 1318 were localized using the tailed method and 13 were localized using the non-tailed method. The localization technical success rate and complications of the microcoil localization procedure were assessed. Univariate and multivariate logistic regression analyses were used to determine potential risk factors for technical failure, pneumothorax, and pulmonary hemorrhage. The technical success rate of the localization procedure was 98.4% (1310/1331 nodules). Nodule location in the lower lobes (p = 0.015) and need for a longer needle path (p < 0.001) were independent predictors of technical failure. All localization procedure-related complications were minor (grade 1 or 2) adverse events, with the exception of one grade 3 complication. The most common complications were pneumothorax (302/1331 nodules [22.7%]) and pulmonary hemorrhage (328/1331 nodules [24.6%]). Male sex (p = 0.001), nodule location in the middle (p = 0.003) and lower lobes (p = 0.025), need for a longer needle path (p < 0.001), use of transfissural puncture (p = 0.042), and simultaneous multiple localizations (p < 0.001) were independent risk factors for pneumothorax. Female sex (p = 0.015), younger age (p = 0.023), nodules location in the upper lobes (p = 0.011), and longer needle path (p < 0.001) were independent risk factors for pulmonary hemorrhage. CT-guided microcoil localization of pulmonary nodules before VATS using either the tailed or non-tailed method is effective and safe. CT-guided microcoil localization of pulmonary nodules before VATS resection is effective and safe when using either the tailed or non-tailed method. Nodules requiring transfissural puncture and multiple nodules requiring simultaneous localizations can also be successfully localized with this method. • Pre-VATS CT-guided microcoil localization of pulmonary nodules by tailed or non-tailed method was effective and safe. • When the feasible puncture path was beyond the scope of wedge resection, localization could be performed using the non-tailed method. • Although transfissural puncture and simultaneous multiple localization were independent risk factors for pneumothorax, they remained clinically feasible.

Intraoperative lung ultrasound improves subcentimetric pulmonary nodule localization during VATS: Results of a retrospective analysis.

Video-assisted thoracoscopic surgery (VATS) resection of deep-seated lung nodules smaller than 1 cm is extremely challenging. Several methods have been proposed to overcome this limitation but with not neglectable complications. Intraoperative lung ultrasound (ILU) is the latest minimally invasive proposed technique. The aim of the current study was to analyze the accuracy and efficacy of ILU associated with VATS to visualize solitary and deep-seated pulmonary nodules smaller than 1 cm. Patients with subcentimetric solitary and deep-seated pulmonary nodules were included in this retrospective study from November 2020 to December 2022. Patients who received VATS aided with ILU were considered as group A and patients who received conventional VATS as group B (control group). The rate of nodule identification and the time for localization with VATS alone and with VATS aided with ILU in each group were analyzed. A total of 43 patients received VATS aided with ILU (group A) and 31 patients received conventional VATS (group B). Mean operative time was lower in group A (p < 0.05). In group A all the nodules were correctly identified, while in group B in one case the localization failed. The time to identify the lesion was lower in group A (7.1 ± 2.2 vs. 13.8 ± 4.6; p < 0.05). During hospitalization three patients (6.5%; p < 0.05) in group B presented air leaks that were conservatively managed. Intracavitary VATS-US is a reliable, feasible, real-time and effective method of localization of parenchymal lung nodules during selected wedge resection procedures.

Preoperative CT-guided localization of pulmonary nodules with low-dose radiation.

Video-assisted thoracoscopic surgery (VATS) has been widely accepted for the treatment of pulmonary nodules. Prior to VATS, pulmonary nodules can be labeled by computed tomography (CT)-guided hook wire localization, but multiple scans are required, which increases the total radiation dose. We aimed to assess the effectiveness and risks of using low-dose radiation CT to locate lung nodules prior to VATS. This study included 158 patients who underwent VATS resection after CT-guided hook wire localization. Based on the CT tube voltage, patients were split into two groups: the low-voltage group (Group A) received 80 kV, while the high-voltage group (Group B) received 120 kV. The two groups' image quality, radiation exposure, localization success and complication rates were compared. The frequencies of intraoperative complications and the types of lung nodules were also compared between the groups. Successful nodule mapping was obtained in 158 patients. There was no significant difference in age, sex ratio or BMI between the two groups. Subjective imaging quality in both groups met the requirements for location (≥2 points). The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in Group A were lower than those in Group B (P<0.05). Furthermore, the dose length product (DLP) and effective dose (ED) in Group A were lower than those in Group B (P<0.05). Low-dose radiation CT-guided localization is safe and feasible for identifying uncertain pulmonary nodules before VATS, enabling a significant radiation dose reduction while maintaining mapping accuracy and not increasing complication risk.

Video-Assisted Thoracic Surgery Without Intraoperative Fluoroscopy After Microcoil Localization

BackgroundSmall nodules and ground-glass opacities can present a challenge when surgeons rely on direct visualization or digital palpation. Preoperative localization improves nodule detection. We aimed to determine the efficacy and safety of video-assisted thoracoscopic surgery (VATS) nodulectomy without intraoperative fluoroscopy after computed tomography (CT)–guided microcoil localization of peripheral pulmonary nodules. MethodsThe cases of 147 consecutive patients (152 nodules) who underwent CT-guided microcoil localization (157 coils) followed by same-day VATS resection between 2016 and 2021 were retrospectively reviewed, and descriptive statistics were reported. ResultsAll 152 nodules (mean size, 13.5 ± 6.1 mm; mean distance to pleura, 4.2 ± 5.5 mm; 82 [54%] ground-glass nodules, 34 [22%] part-solid nodules) in study patients (mean age, 64.6 ± 11.8 years) were successfully resected. The technical success rate of percutaneous nodule localization with pleural tagging was 96% (150/157); the surgical efficacy of VATS nodulectomy without intraoperative fluoroscopy was 98% (149/152). Twelve patients (8%) required chest tubes after localization. Pathologic examination identified 24 benign and 123 malignant nodules, including 85 primary lung cancers. ConclusionsCT-guided microcoil localization with pleural tagging is safe and effective and obviates the need for intraoperative fluoroscopy.

Computed Tomography-guided Techniques for Localizing Pulmonary Nodules by Localization Needle versus Methylene Blue.

The aim of this study was to evaluate the clinical value of computed tomographyguided localization needle (LN) and methylene blue (MB) for pulmonary nodule localization. Between November 2019 and January 2022, 547 patients underwent computed tomography-guided LN (n=171) or MB (n=376) localization and video-assisted thoracoscopic surgery (VATS) resection. In total, 171 and 376 nodules were localized via LN and MB, respectively, with respective technical localization success rates of 92.98 % and 88.56 % (p = 0.111). The pulmonary nodule localization time was significantly shorter for the MB group than for the LN group (p < 0.05). However, the rates of total complication, chest pain, and cough were significantly lower in the LN group (χ2 = 8.251/25.092/5.127, all p < 0.05). Furthermore, the LN group had a shorter VATS time than the MB group (p < 0.05). The VATS achieved a 100% operation success rate in both groups, and there was no significance between groups with respect to the types of surgery (p > 0.05) or the blood loss (p > 0.05). Moreover, logistic regression analysis showed that the localization technique was an independent risk factor for total complications and chest pain. Both techniques can effectively localize pulmonary nodules before VATS. MB had a shorter localization time, but the LN had a shorter VATS time and a lower incidence of complications, especially chest pain.

Effectiveness of PET/CT and VATS for detecting and treating internal mammary lymph node metastasis: a case series.

We occasionally observed internal mammary lymph node metastases of breast cancer in a clinical setting. However, unlike a standard treatment in axillary metastasis, surgical resection for internal mammary lymph node metastasis is not prevalent because of unclear safety and benefits. Thus, we aimed to evaluate the diagnostic ability and clinical outcomes of positron emission tomography/computed tomography and video-assisted thoracoscopic surgery. We retrospectively investigated 34 patients with breast cancer with abnormal 18F-fluorodeoxyglucose uptake in internal mammary lymph nodes, at a single centre, between January 2015 and June 2022 and identified 11 female patients (mean age±SD, 51.5±12.9years) who underwent video-assisted thoracoscopic surgery resection. Positron emission tomography/computed tomography was used to determine the clinical stage. We reviewed the surgical pathology of eleven and two patients who underwent direct-view internal mammary lymph node resection to calculate the positive predictive value of positron emission tomography/computed tomography. Ipsilateral fluorodeoxyglucose accumulation was observed, with an average maximum standardized uptake value of 8.9 (range, 3.1-24.0). No perioperative complications occurred, and all patients who underwent video-assisted thoracoscopic surgery alone were discharged from the hospital on post-operative day 2 or 3. The estimated positive predictive value was 80%. All patients were alive, and seven of nine patients with metastasis were relapse-free, at a mean follow-up period of 17.9months (range, 1-51). However, two patients had recurrence at 16 and 14months after surgery for internal mammary lymph node relapse. Radiotherapy is the standard treatment for suspected internal mammary lymph node metastasis detected using positron emission tomography/computed tomography; however, we could safely perform minimally invasive video-assisted thoracoscopic surgery resection, leading to a definite pathological diagnosis.

Retracted: Clinical Analysis of Video-Assisted Thoracoscopic Surgery for Resection of Solitary Pulmonary Nodules and Influencing Factors in the Diagnosis of Benign and Malignant Nodules.

[This retracts the article DOI: 10.1155/2021/1490709.].