Intraoperative marking of pulmonary nodules in a hybrid operating room: electromagnetic navigation bronchoscopy versus percutaneous marking.

IF 1.6 4区医学 Q2 SURGERY Frontiers in Surgery Pub Date : 2024-09-30 eCollection Date: 2024-01-01 DOI:10.3389/fsurg.2024.1482120

María Teresa Gómez-Hernández, Cristina E Rivas Duarte, José María Fernández García-Hierro, Marta G Fuentes, Oscar Colmenares, Clara Forcada Barreda, Francisco Gómez Valle, Irene Jiménez García, Marcelo F Jiménez

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Abstract

Background: Intraoperative identification of subsolid or small pulmonary nodules during minimally invasive procedures is challenging. Recent localization techniques show varying success and complications. Hybrid operating rooms (HORs), equipped with radiological tools, facilitate intraoperative imaging. This study compares the accuracy and safety of marking pulmonary nodules using electromagnetic navigation bronchoscopy (ENB) combined with Cone Beam Computed Tomography (CBCT) vs. CBCT-guided percutaneous marking (PM).

Methods: This retrospective cohort study included patients with pulmonary nodules scheduled for minimally invasive resection in a HOR. Marking techniques included ENB assisted by CBCT and PM guided by CBCT. The study compared the success rate, procedure time, intraoperative complications and radiation dose of both techniques.

Results: A total of 104 patients with 114 nodules were included (October 2021-July 2024). Thirty nodules were marked using ENB, and 84 with PM. One case used both techniques due to ENB failure. No differences among groups were found in nodule characteristics. Success rates were similar (93.3% in ENB group vs. 91.7% in PM group, p = 1). Marking took significantly longer time in the ENB group (median 40 min) compared to PM group (25 min, p = 0.007). Five (6%) patients in the PM group experienced intraoperative complications compared to none in the ENB (p = 0.323). Radiation dose was significantly higher in the ENB group (p = 0.002).

Conclusions: ENB assisted by CBCT is a safe and effective technique, with success rates comparable to CBCT-guided PM, though it may result in longer procedural times and higher radiation doses.

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混合手术室肺结节的术中标记：电磁导航支气管镜与经皮标记。

背景：在微创手术中术中识别实性下或小的肺结节具有挑战性。最新的定位技术显示出不同的成功率和并发症。配备了放射工具的混合手术室（HOR）为术中成像提供了便利。本研究比较了使用电磁导航支气管镜（ENB）结合锥形束计算机断层扫描（CBCT）与 CBCT 引导下经皮标记（PM）标记肺结节的准确性和安全性：这项回顾性队列研究纳入了计划在 HOR 进行微创切除术的肺结节患者。标记技术包括 CBCT 辅助的 ENB 和 CBCT 引导的 PM。研究比较了两种技术的成功率、手术时间、术中并发症和辐射剂量：共纳入 104 名患者，114 个结节（2021 年 10 月至 2024 年 7 月）。其中 30 个结节使用 ENB 标记，84 个使用 PM 标记。一个病例因 ENB 失败而同时使用了两种技术。各组结节特征无差异。成功率相似（ENB 组 93.3% 对 PM 组 91.7%，P = 1）。ENB 组的标记时间（中位 40 分钟）明显长于 PM 组（25 分钟，P = 0.007）。PM 组有五名（6%）患者出现术中并发症，而 ENB 组无并发症（p = 0.323）。ENB组的放射剂量明显更高（p = 0.002）：由 CBCT 辅助的 ENB 是一种安全有效的技术，成功率与 CBCT 引导的 PM 相当，但可能导致手术时间延长和辐射剂量增加。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Surgery Medicine-Surgery

CiteScore

1.90

自引率

11.10%

发文量

1872

审稿时长

12 weeks

期刊介绍： Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.