Trans-fissure and trans-lobar coil insertion technique for small lesions positioned inside the fissure

Abstract

The objective of this study is to present a technique of localization of difficult-to-locate lesions inside the fissure by deploying a coil with one of its ends left inside the fissure, and also, to evaluate the safety and the efficiency of this localization technique. Ten (10) patients with lesions in the fissure were identified during discussion at the multidisciplinary team meeting (MDT) and were recruited in the study. Attending surgeons verified that the lesions were unable to be located with minimally invasive approaches. These patients underwent localization of their lesion/s inside the fissure with a coil which was inserted through an adjacent lobe, through the fissure and inside the lesion with the other end protruding inside the fissure. All patients were next subjected to resection of their lesions with minimally invasive approaches. All patients had their lesions resected (with wedge resection or segmentectomies) with adequate margins (R0 resection). No conversion to thoracotomy was necessitated to attempt to palpate the lesion. Small, localized pneumothorax was noted in 7 patients; whereas, all patients had small laceration of their lung parenchyma along the course of the needle without, however, any action needed for these sequalae. The presented technique offers precise localization which leads to successful and safe resection of difficult-to-locate lesions inside the fissure via minimally invasive approaches. The clinical implications of this technique are numerous and its utilization can augment the successful performance of minimally invasive techniques for lesions situated inside the fissure.

Keywords: Coil; Localization; Minimally invasive; Trans-fissure; Trans-lobar.