Clock dial integrated positioning combined with single utility port video-assisted thoracoscopic surgery: a new localization method for lung tumors

Abstract

Background: Preoperative localization of lung tumor mainly consisted of two methods: CT-guided percutaneous localization and electromagnetic navigation bronchoscopy-guided localization. However, these invasive methods could result in serious complications. In order to avoid the adverse effects of preoperative invasive localization, we propose a method of intraoperative noninvasive localization for lung tumors: clock dial integrated positioning (CDIP).

Methods: To retrospectively analyze the clinic data about the application of CDIP for 127 lung tumour patients in single utility port video-assisted thoracoscopic surgery (SUPVATS) between June 2017 and October 2017.

Results: One hundred and twenty-four cases (97.64%) underwent thoracoscopic surgery, which including 14 lobectomy, 107 partial resection, 2 lobectomy plus partial resection and 1 left pneumonectomy. Three cases (2.36%) underwent thoracoscopic biopsy. The mean operation time and intraoperative bleeding were 47.9±22.1 min and 70.1±40.3 mL, respectively. The mean postoperative hospital stay and chest drain duration were 3.9±2.2 and 3.6±1.8 days, respectively. There were 118 cases of malignant tumors, including adenocarcinoma (n=101), squamous cell carcinoma (n=9), large cell carcinoma (n=2), small cell lung carcinoma (n=3), and metastatic lung carcinoma (n=3). The remaining nine cases were benign tumors, including granuloma (n=3), intrapulmonary lymph node (n=2), sclerosing hemangioma (n=2), and hamartoma (n=2). The incidence of postoperative complications was 10.2%. There was no mortality, secondary operation, or conversion to open procedure due to massive intraoperative bleeding.

Conclusions: CDIP combined with SUPVATS is a safe, feasible, and effective method for the localization of lung tumors. This novel method can provide a reliable alternative technique when the marker is dislocated.

Keywords: Clock dial integrated positioning (CDIP); lung tumors; non-small cell lung cancer (NSCLC); single utility port video-assisted thoracoscopic surgery (SUPVATS).

Figure 1

Based on the CT scan, we calculated the part of the lung in which the tumor was located (according to the azygos vein arch, aortic arch, and lower pulmonary vein). We also calculated the clock dial position of the tumor. The thick black arrow indicates a tumor.

Figure 2

The method of clock dial integrated positioning (CDIP). (A) The clock dial integrated positioning shown on the right side of the tumors before surgery; (B) clockwise rotation of 90 degrees, the tumor is located at the 9 o’clock position and above the azygos arch is belongs to the upper part; (C) on the left side of the tumor before surgery; (D) counterclockwise rotation of 90 degrees, the tumor is located at the 1 o’clock position and is at the level of the lower pulmonary vein. Arrows indicate changes in the chest.

Figure 3

The CDIP located the right upper lung tumor intraoperatively. (A) The CDIP shown on the right side of the tumor is located at the 1 o’clock position and above the azygos arch in the upper part before surgery; (B) the area is above the azygos arch that is located at the 1 o’clock position during the surgery; (C) SUPVATS excision of the tumors; (D) tumors were located in this area. CDIP, clock dial integrated positioning; SUPVATS, single utility port video-assisted thoracoscopic surgery.