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Clinical Trial
. 2012 Nov;144(5):1160-5.
doi: 10.1016/j.jtcvs.2012.08.034. Epub 2012 Sep 12.

Thoracoscopic localization of intraparenchymal pulmonary nodules using direct intracavitary thoracoscopic ultrasonography prevents conversion of VATS procedures to thoracotomy in selected patients

Mohamed Khereba  1 , Pasquale Ferraro, Andre Duranceau, Jocelyne Martin, Eric Goudie, Vicky Thiffault, Moishe Liberman
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Free article
Clinical Trial

Thoracoscopic localization of intraparenchymal pulmonary nodules using direct intracavitary thoracoscopic ultrasonography prevents conversion of VATS procedures to thoracotomy in selected patients

Mohamed Khereba et al. J Thorac Cardiovasc Surg. 2012 Nov.
Free article

Abstract

Objectives: To investigate the feasibility, accuracy, and effect on conversion rates of intracavitary video-assisted thoracoscopic surgery ultrasonography (VATS-US) for localization of difficult to visualize pulmonary nodules.

Methods: The study consisted of a prospective cohort of VATS-US for localization of intraparenchymal peripheral pulmonary nodules. Patients with pulmonary nodules not touching the visceral pleura on the computed tomography scan, who were scheduled for VATS wedge resection, were prospectively enrolled. The lobe of interest was examined: visually, using finger palpation when possible, and using the instrument sliding method. The nodule was then sought using a sterile ultrasound transducer. The primary outcome measure was the prevention of conversion to thoracotomy or lobectomy secondary to positive VATS-US findings in patients with nodules that were not identifiable using standard VATS techniques.

Results: Four different surgeons performed 45 individual VATS-US procedures during a 13-month period. Intracavitary VATS-US was able to detect 43 of 46 nodules. The sensitivity of VATS-US was 93%, and the positive predictive value was 100%. The lung nodules were visualized by thoracoscopic lung examination in 12 cases (27%), palpable by finger in 18 cases (40%), and palpable using the instrument sliding technique in 17 cases (38%). In 20 cases, lung nodules were not identifiable using any of the traditional techniques and were identified only with VATS-US. VATS-US, therefore, prevented conversion to thoracotomy or lobectomy without tissue diagnosis in 43% (20/46) of cases.

Conclusions: Intracavitary VATS-US is a real-time, feasible, reliable, and effective method of localization of intraparenchymal pulmonary nodules during selected VATS wedge resection procedures and can decrease the conversion rates to thoracotomy or lobectomy.

Trial registration: ClinicalTrials.gov NCT01201824.

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Comment in

  • Discussion.
    [No authors listed] [No authors listed] J Thorac Cardiovasc Surg. 2012 Nov;144(5):1165-6. doi: 10.1016/j.jtcvs.2012.08.038. Epub 2012 Sep 12. J Thorac Cardiovasc Surg. 2012. PMID: 22980666 No abstract available.
  • Is intracavitary thoracoscopic ultrasonography really needed for every intraparenchymal pulmonary nodule?
    Liu C, Pu Q, Liu L. Liu C, et al. J Thorac Cardiovasc Surg. 2013 Apr;145(4):1151. doi: 10.1016/j.jtcvs.2012.12.089. J Thorac Cardiovasc Surg. 2013. PMID: 23497954 No abstract available.
  • Reply to the editor.
    Liberman M. Liberman M. J Thorac Cardiovasc Surg. 2013 Apr;145(4):1151-1152. doi: 10.1016/j.jtcvs.2013.01.013. J Thorac Cardiovasc Surg. 2013. PMID: 23497955 No abstract available.

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