Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr 5:9:872496.
doi: 10.3389/fsurg.2022.872496. eCollection 2022.

Electromagnetic Navigation Bronchoscopy Integrated Non-intubated Uniportal VATS in Localization and Resection of Pulmonary Nodules

Rui Wang  1   2 , Yu Jiang  1   2 , Jiaxi He  1   2 , Yuechun Lin  1   2 , Zhufeng Wang  2 , Shuben Li  1   2
Affiliations

Electromagnetic Navigation Bronchoscopy Integrated Non-intubated Uniportal VATS in Localization and Resection of Pulmonary Nodules

Rui Wang et al. Front Surg. .

Abstract

Background: With the development of computed tomography, the detection rate of pulmonary nodules is increasing. Accurate localization, minimally invasive resection, and rapid recovery are the most concentrated issues in modern thoracic surgery. However, some traditional procedures, including CT-guided localization and general intubated anesthesia, might prolong the operation and postoperative recovery. The integrated operating room provides a practical approach to achieve precise pulmonary nodule localization with real-time images using electromagnetic navigation bronchoscopy (ENB). Meanwhile, the minimally invasive video-assisted thoracoscopic surgery (VATS) under non-intubated anesthesia is also applied in the same place, enhancing operative efficiency and recovery after surgery.

Method: The patients with pulmonary nodules resection who underwent nodules localization and uniportal VATS under non-intubated anesthesia in the integrated operating room between September 2018 and December 2021 were identified and collected. They all received ENB localization before uniportal VATS under non-intubated anesthesia, provided by the same group of anesthesiologists and surgeons. Perioperative data of patients were analyzed and evaluated to demonstrate the feasibility and efficiency of the procedure.

Result: A total of 243 patients with 251 pulmonary nodules underwent ICG staining localization by ENB. The mean calibration time and navigation time were 0.91 ± 0.43 min and 10.56 ± 7.24 min, respectively. Overall, successful navigation occurred in 248 (98.80%) nodules. All patients received thoracoscopic surgery after localization, including wedge resection (231, 92.03%), segmentectomy (13, 5.18%), and lobectomy (7, 2.79%). All nodules were completely resected without serious complications. The mean postoperative hospital was 1.80 ± 0.83 days.

Conclusion: ENB localization and nodules resection under non-intubated uniportal VATS in the integrated operating room provides a feasible and efficient approach to the pulmonary nodules patients, favoring the treatment precision and enhanced recovery.

Keywords: electromagnetic navigation bronchoscopy; integrated operating room; non-intubated anesthesia; pulmonary nodule; video-assisted thoracoscopic surgery.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The diagram of electromagnetic navigation bronchoscopy (ENB) for pulmonary nodule localization.
Figure 2
Figure 2
The diagram of uniportal NIVATS in subxiphoid approach.
Figure 3
Figure 3
Pathological results of nodules: minimally invasive adenocarcinoma (MIA,109,43.43%), invasive adenocarcinoma (IA,46,18.32%), adenocarcinoma in situ (AIS,30,11.95%), atypical adenomatous hyperplasia (AAH,12,4.78%), mucin-producing adenocarcinoma (MPA, 2, 0.80%), other including metastatic tumor, pulmonary hamartoma, aspergillus nodules, tuberculoma, fibrous nodule, granuloma, et al. (52,20.72%).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Bai C, Choi C-M, Chu CM, Anantham D, Ho JC, Khan AZ, et al. . Evaluation of pulmonary nodules: clinical practice consensus guidelines for Asia. Chest. (2016) 150:877–93. 10.1016/j.chest.2016.02.650 - DOI - PubMed
    1. Leshnower BG, Miller DL, Fernandez FG, Pickens A, Force SD. Video-assisted thoracoscopic surgery segmentectomy: a safe and effective procedure. Ann Thorac Surg. (2010) 89:1571–6. 10.1016/j.athoracsur.2010.01.061 - DOI - PubMed
    1. Abbas AE. Surgical management of lung cancer: history, evolution, and modern advances. Curr Oncol Rep. (2018) 20:98. 10.1007/s11912-018-0741-7 - DOI - PubMed
    1. Wen Y, Liang H, Qiu G, Liu Z, Liu J, Ying W, et al. . Non-intubated spontaneous ventilation in video-assisted thoracoscopic surgery: a meta-analysis. Eur J Cardiothorac Surg. (2020) 57:428–37. 10.1093/ejcts/ezz279 - DOI - PubMed
    1. Yu M, Jing R, Mo Y, Lin F, Du X, Ge W, et al. . Non-intubated anesthesia in patients undergoing video-assisted thoracoscopic surgery: a systematic review and meta-analysis. PLoS ONE. (2019) 14:e0224737. 10.1371/journal.pone.0224737 - DOI - PMC - PubMed

LinkOut - more resources