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. 2020 Jun;121(8):1225-1232.
doi: 10.1002/jso.25897. Epub 2020 Mar 12.

Image-guided video-assisted thoracoscopic resection (iVATS): Translation to clinical practice-real-world experience

Ritu R Gill  1 , Julianne Barlow  2 , Michael T Jaklitsch  2 , Eric J Schmidlin  3 , Phillip M Hartigan  4 , Raphael Bueno  2
Affiliations

Image-guided video-assisted thoracoscopic resection (iVATS): Translation to clinical practice-real-world experience

Ritu R Gill et al. J Surg Oncol. 2020 Jun.

Abstract

Objective: We developed a novel approach for localization and resection of lung nodules, using image-guided video-assisted thoracoscopic surgery (iVATS). We report our experience of translating iVATS into clinical care.

Methods: Methodology and workflow for iVATS developed as part of the Phase I/II trial were used to train surgeons, radiologists, anesthesiologists, and radiology technologists. Radiation dose, time from induction to incision, placement of T-bar to incision and incision to closure, hospital stay, and complication rates were recorded.

Results: Fifty patients underwent iVATS for resection of 54 nodules in a clinical hybrid operating room (OR) by six surgeons. Fifty-two (97%) nodules were successfully resected. Forty-two (84%) patients underwent wedge resection, four (7%) lobectomies, and two (4%) segmentectomy all with lymph node dissection. Median time from induction to incision was 89 minutes (range: 13-256 minutes); T-bar placement was 14 minutes (10-29 minutes); and incision to closure, 107 minutes (41-302 minutes). Average and total procedure radiation dose were: median = 6 mSieverts (range: 2.9-35 mSieverts). No deaths were reported and median length of stay was 3 days (range: 1-12 days).

Conclusions: Translation of iVATS into clinical practice has been initiated using a safe step-wise process, combining intraoperative C-arm computed tomography scanning and thoracoscopic surgery in a hybrid OR.

Keywords: C-arm CT; VATS; advanced image-guided operating room; fiducials; hybrid operating room; lung cancer.

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Conflict of interest statement

Dr. Raphael Bueno has funding from NIBIB 5 R01 EB025964‐02, and reports other grant funding from Siemens, Genentech, Roche, Merck, Verastem, Epizyme, Gritstone, Medgenome; personal fees from Novocure, outside the submitted work; and Patent licensed through BWH, Equity in an early start up device company‐Navigation Sciences. Gill reports grant funding from Siemens Healthineers, grants from NIH, grants from Canon Inc., outside the submitted work.

Figures

Figure 1
Figure 1
CONSORT diagram depicting the schema of the study
Figure 2
Figure 2
A, Axial computed tomography (CT), 3D volume rendered and sagittal and coronal cone beam CT images, of patient with two nodules resected in the same procedure; the size, morphology location, and T‐bar path (green lines) are depicted [Color figure can be viewed at wileyonlinelibrary.com]
Figure 3
Figure 3
Pictorial display of the anterior and posterior surface of the lungs with all the nodule locations marked as a case number
Figure 4
Figure 4
Bar graph shows the time per case with the time for each component; red color represents the time taken for T‐bar placement; blue color represents the time for induction to incision; and green color represents the time for incision to closure in minutes [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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