Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series
Background: Video-assisted thoracoscopic (VATS) lung resections are increasingly popular and localization techniques are necessary to aid resection. We describe our experience with hybrid operating room (OR) cone-beam computed tomography (CT) assisted pre-operative and intra-operative lesion localiz...
| Main Authors: | , , , , , , |
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| Format: | Journal Article |
| Language: | English |
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2024
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| Online Access: | https://hdl.handle.net/10356/175468 |
| _version_ | 1826109799518961664 |
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| author | Chia, Audrey Qi Xin Gogna, Apoorva Pena, Angela Maria Takano Sai, Vishnu Vemula Sri Chandramohan, Sivanathan Chan, Shaun Xavier Ju Min Ong, Boon-Hean |
| author2 | Lee Kong Chian School of Medicine (LKCMedicine) |
| author_facet | Lee Kong Chian School of Medicine (LKCMedicine) Chia, Audrey Qi Xin Gogna, Apoorva Pena, Angela Maria Takano Sai, Vishnu Vemula Sri Chandramohan, Sivanathan Chan, Shaun Xavier Ju Min Ong, Boon-Hean |
| author_sort | Chia, Audrey Qi Xin |
| collection | NTU |
| description | Background: Video-assisted thoracoscopic (VATS) lung resections are increasingly popular and localization techniques are necessary to aid resection. We describe our experience with hybrid operating room (OR) cone-beam computed tomography (CT) assisted pre-operative and intra-operative lesion localization of lung nodules for VATS wedge resections, including our novel workflow using the hybrid OR cone-beam CT to re-evaluate patients who have undergone pre-operative localization for those who are unsuitable for intra-operative localization. Methods: Retrospective analysis of all consecutive patients with small (≤ 20 mm), deep (≥ 10 mm distance from pleura) and/or predominantly ground-glass nodules selected for lesion localization in the Interventional Radiology suite followed by re-evaluation with cone-beam CT in the hybrid OR (pre-operative), or in the hybrid OR alone (intra-operative), prior to intentional VATS wedge performed by a single surgeon at our centre from January 2017 to December 2021. Results: 30 patients with 36 nodules underwent localization. All nodules were successfully resected with a VATS wedge resection, although 10% of localizations had hookwire or coil dislodgement. The median effective radiation dose in the pre-operative group was 10.4 mSV including a median additional radiation exposure of 0.9 mSV in the hybrid OR for reconfirmation of hookwire or coil position prior to surgery (p = 0.87). The median effective radiation dose in the intra-operative group was 3.2 mSV with a higher mean rank than the intra-operative group, suggesting a higher radiation dose (p = 0.01). Conclusions: We demonstrate that our multidisciplinary approach utilizing the hybrid OR is safe and effective. Intra-operative localization is associated with lower radiation doses. Routine use of cone-beam CT to confirm the position of the physical marker prior to surgery in the hybrid OR helps mitigate consequences of localization failure with only a modest increase in radiation exposure. |
| first_indexed | 2024-10-01T02:24:16Z |
| format | Journal Article |
| id | ntu-10356/175468 |
| institution | Nanyang Technological University |
| language | English |
| last_indexed | 2024-10-01T02:24:16Z |
| publishDate | 2024 |
| record_format | dspace |
| spelling | ntu-10356/1754682024-04-28T15:42:45Z Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series Chia, Audrey Qi Xin Gogna, Apoorva Pena, Angela Maria Takano Sai, Vishnu Vemula Sri Chandramohan, Sivanathan Chan, Shaun Xavier Ju Min Ong, Boon-Hean Lee Kong Chian School of Medicine (LKCMedicine) Medicine, Health and Life Sciences Sublobar resection Nodule localization Background: Video-assisted thoracoscopic (VATS) lung resections are increasingly popular and localization techniques are necessary to aid resection. We describe our experience with hybrid operating room (OR) cone-beam computed tomography (CT) assisted pre-operative and intra-operative lesion localization of lung nodules for VATS wedge resections, including our novel workflow using the hybrid OR cone-beam CT to re-evaluate patients who have undergone pre-operative localization for those who are unsuitable for intra-operative localization. Methods: Retrospective analysis of all consecutive patients with small (≤ 20 mm), deep (≥ 10 mm distance from pleura) and/or predominantly ground-glass nodules selected for lesion localization in the Interventional Radiology suite followed by re-evaluation with cone-beam CT in the hybrid OR (pre-operative), or in the hybrid OR alone (intra-operative), prior to intentional VATS wedge performed by a single surgeon at our centre from January 2017 to December 2021. Results: 30 patients with 36 nodules underwent localization. All nodules were successfully resected with a VATS wedge resection, although 10% of localizations had hookwire or coil dislodgement. The median effective radiation dose in the pre-operative group was 10.4 mSV including a median additional radiation exposure of 0.9 mSV in the hybrid OR for reconfirmation of hookwire or coil position prior to surgery (p = 0.87). The median effective radiation dose in the intra-operative group was 3.2 mSV with a higher mean rank than the intra-operative group, suggesting a higher radiation dose (p = 0.01). Conclusions: We demonstrate that our multidisciplinary approach utilizing the hybrid OR is safe and effective. Intra-operative localization is associated with lower radiation doses. Routine use of cone-beam CT to confirm the position of the physical marker prior to surgery in the hybrid OR helps mitigate consequences of localization failure with only a modest increase in radiation exposure. Published version 2024-04-24T07:28:12Z 2024-04-24T07:28:12Z 2024 Journal Article Chia, A. Q. X., Gogna, A., Pena, A. M. T., Sai, V. V. S., Chandramohan, S., Chan, S. X. J. M. & Ong, B. (2024). Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series. Journal of Cardiothoracic Surgery, 19(1), 85-. https://dx.doi.org/10.1186/s13019-024-02564-7 1749-8090 https://hdl.handle.net/10356/175468 10.1186/s13019-024-02564-7 38341594 2-s2.0-85184790002 1 19 85 en Journal of Cardiothoracic Surgery © The Author(s) 2024. Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecom mons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. application/pdf |
| spellingShingle | Medicine, Health and Life Sciences Sublobar resection Nodule localization Chia, Audrey Qi Xin Gogna, Apoorva Pena, Angela Maria Takano Sai, Vishnu Vemula Sri Chandramohan, Sivanathan Chan, Shaun Xavier Ju Min Ong, Boon-Hean Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series |
| title | Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series |
| title_full | Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series |
| title_fullStr | Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series |
| title_full_unstemmed | Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series |
| title_short | Hybrid operating room with ceiling mounted imaging system assisted pre-operative and intra-operative lung nodule localization for thoracoscopic resections: a 5-year case series |
| title_sort | hybrid operating room with ceiling mounted imaging system assisted pre operative and intra operative lung nodule localization for thoracoscopic resections a 5 year case series |
| topic | Medicine, Health and Life Sciences Sublobar resection Nodule localization |
| url | https://hdl.handle.net/10356/175468 |
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