Extended Segmentectomy for Small Lung Nodule with Image-Guided Video-Assisted Thoracoscopic Surgery

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Austin Surg Case Rep. 2021; 6(1): 1042.

Extended Segmentectomy for Small Lung Nodule with Image-Guided Video-Assisted Thoracoscopic Surgery

Cheng YF1 and Wang BY1-6*

1Department of Surgery, Division of Thoracic Surgery, Changhua Christian Hospital, Taiwan

2Kaohsiung Medical University, College of Medicine, Taiwan

3National Chung Hsing University, Institute of Genomics and Bioinformatics, Taiwan

4National Chung Hsing University, Program in Translational Medicine, Taiwan

5Chung Shan Medical University, School of Medicine, Taiwan

6Ming Dao University, Center for General Education, Changhua, Taiwan

*Corresponding author: Bing-Yen Wang, Department of Surgery, Division of Thoracic Surgery, Changhua Christian Hospital, No. 135 Nanxiao St, Changhua City, Changhua County 500, Taiwan

Received: March 01, 2021; Accepted: March 25, 2021; Published: April 01, 2021

Abstract

Patients with clinical T1aN0M0 Non-Small Cell Carcinoma (NSCLC) or poor pulmonary function may benefit more from segmentectomy compared to lobectomy. However, there is question about segmentectomy provides not enough safe margin, especially for nodules situated at the intersegmental area. We describe a novel technique using image-guided Video-Assisted Thoracoscopic Surgery (iVATS) to accomplish extended segmentectomy for central lung nodules. This technique helps to overcome the challenges of nodules situated at the intersegmental area.

Keywords: Extended segmentectomy; Image-guided video-assisted thoracoscopic surgery; Non-small cell carcinoma; Resection margin

Introduction

In this decade, the technique of image-guided Video-Assisted Thoracoscopic Surgery (iVATS) has become more and more popular. Previous studies proved that iVATS is a safe and feasible way to remove Solitary Pulmonary Nodules (SPNs) and improve patient care [1].

Several studies have discussed in detail the experience of iVATS with cone-beam CT. The learning curve, patient’s position, single incision, localization material, dual-marker technique and bilateral resection were reported [2,3]. However, the applications of iVATS for central lung nodules and segmentectomy have not been explored.

Here, we describe a novel technique using iVATS to accomplish extended segmentectomy for central lung nodules. This technique helps to overcome the challenges of nodules situated at the intersegmental area. In traditional thoracoscopic segmentectomy, it is hard to make a safe margin for these nodules.

Surgical Technique and Patient Results

The Institutional Review Board (IRB) of our hospital approved this study and inform consent was waived by our institute’s IRB. Under general anesthesia, patients were positioned in the lateral decubitus position in a hybrid operating room. All lines and tubes were secured and taped. We used robotic C-arm cone beam CT (Artis Pheno; Siemens Healthcare GmbH, Forchheim, Germany) for the scanning. Before the scanning, we performed a test C-arm movement to ensure the scanner would not collide with the patient. The entire scan was performed with breath hold at end inspiration by clamping the endotracheal tube.

We measured the shortest nodule distance to the pleura point at axial view and laid out the needle path under the syngo Needle Guidance of a syngo X-Workplace with a three-dimensional view. We set the guidance needle to a depth around 10mm in the pleura toward the nodule. A cross laser beam for incision location was projected onto the patient’s skin. We punctured an 18-gauge marker needle into the thorax with the cross-laser guidance after breath holding (Figure 1a). After another scan for confirmation of the appropriate needle location (Figure 1b), diluted methylene blue dye (0.15ml) plus normal saline (0.25ml) were injected. The purpose of this volume helped methylene blue dye to see within 5-millimeter diameter on the surface of the lung and not to color the nodule. The operation started after sterilization and one lung ventilation.

Citation: Cheng YF and Wang BY. Extended Segmentectomy for Small Lung Nodule with Image-Guided Video-Assisted Thoracoscopic Surgery. Austin Surg Case Rep. 2021; 6(1): 1042.