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. 2025 Jul 3;40(7):ivaf152.
doi: 10.1093/icvts/ivaf152.

Hybrid treatment of multifocal lung malignancy by concomitant transbronchial microwave ablation with same-session lung resection and post-lung resection ablation

Aliss T C Chang  1 , Joyce W Y Chan  1 , Ivan C H Siu  1 , Rainbow W H Lau  1 , Cheuk Man Chu  2 , Tony S K Mok  3 , Calvin S H Ng  1
Affiliations

Hybrid treatment of multifocal lung malignancy by concomitant transbronchial microwave ablation with same-session lung resection and post-lung resection ablation

Aliss T C Chang et al. Interdiscip Cardiovasc Thorac Surg. .

Abstract

Objectives: Transbronchial microwave ablation may have additional value when performed with the same-session lung resection or in patients with a history of lung resection(s). We present our institutional cohort to assess the feasibility and safety of transbronchial microwave ablation with the presence of lung resection.

Methods: From March 2019 to February 2024, 92 patients who underwent transbronchial microwave ablation with either a history of major lung resection(s) or same-session ablation with concomitant video-assisted thoracoscopic lung resection(s) were included in this study. Procedural details, safety outcomes and length of stay were retrospectively analysed.

Results: There were 103 episodes of transbronchial microwave ablation performed, and 142 lung lesions were ablated. The average size of nodules was 11.80 mm. Technical success was 100% with a mean minimum margin of 6 mm. Complications occurred in 23 procedures; the majority were CTCAE grade 1 complications (74%), which resolved shortly with observation, and the rest were grade 2 and 3 complications (13%), including one case of bronchopleural fistula and two cases of pneumothorax that required drainage. The average length of stay was 1.46 days. A total of 11 cases of same-session ablation with lung resection were performed. The average procedural time was 226 min, which is significantly shorter than the 27 cases of separate surgery and ablation during the same period (P = 0.012).

Conclusions: Performing transbronchial microwave ablation utilizing electromagnetic navigation bronchoscopic guidance is feasible and safe in the background of lung resection. This technique can also be incorporated into a one-stop treatment with concomitant lung resection.

Keywords: hybrid operating room; multifocal lung cancer; transbronchial microwave ablation; video-assisted thoracoscopic surgery.

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Conflict of interest statement

Prof. Calvin S.H. Ng: consultant to Johnson and Johnson, Medtronic and Siemens Healthineer. Dr Rainbow W.H. Lau: consultant to Medtronic and Siemens Healthineer.

Figures

None
Graphical abstract
Figure 1:
Figure 1:
(a) HOR setup for bronchoscopic navigation under ENB guidance. (b) Real-time CBCT performed after TMWA to assess ablation zone coverage. (c) Real-time fluoroscopic image showing successful triple dye marking with clearly visualized hyperdense contrast agent near the target nodule. (d) Intraoperative near-infrared camera helps identify the Indocyanine green dye marking for accurate localization of nodule during VATS lung resection. (e) Schematic diagram of the routine workflow for a case of concomitant TMWA with ipsilateral wedge resection of the lung
See this image and copyright information in PMC

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