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- Title
V-080 INTRAOPERATIVE DYNA-COMPUTED TOMOGRAPHY TO RESECT UNPALPABLE LUNG CANCER.
- Authors
Sakuragi, Tohru; Hisano, H.; Kakiuchi, Y.; Nakayama, Y.; Morita, S.
- Abstract
Objectives: Pure ground glass nodules (GGN), early lung cancer with only lepidic growth, may be treated surgically by sublobar resection or segmentectomy. Localization of these lesions is challenging in video assisted thoracic surgery (VATS). Marking of these tumours using hook wires, dyes, or contrast media under preoperative CT guidance has been reported. However, lack of general anaesthesia during the CT intervention causes anxiety in patients. The use of hook wires has been recently linked with fatal cerebral and cardiac air embolism. DynaCT allows the reconstruction of CT-like images in hybrid operating rooms without the need of transporting and repositioning the patient on an operating table.Video description: In a 63-year-old male patient, we performed VATS with 3 ports using intraoperative tumour marking by DynaCT guidance. The patient was placed in a lateral position. After insertion of the thoracoscope, the re-inflated lung was scanned by DynaCT, which showed all three shadows. Based on the DynaCT view, two needle markers (4-0 Prolene®) were placed on the lung surface through the surgical port to have landmarks indicating the nodules. A subsequent lung scan demonstrated the spatial relationship between markers and nodules. A third needle was placed as a landmark to ensure sufficient surgical margins for anatomical segmentectomy, which was confirmed by a third DynaCT scan.The patient underwent a radical right middle lobectomy for solitary lung adenocarcinoma, and limited resections for adenocarcinomas in situ in the right upper lobe (segmental resection of the posterior segment and partial resection of the anterior segment) by VATS. The patient is free of recurrence 2 years postoperatively.Conclusions: We believe that this novel technology has great potential for lung cancer surgery because it allows the identification of small target tumours and safety margins and thereby increases the surgeon's confidence during the procedure.Disclosure: No significant relationships.
- Publication
Interactive Cardiovascular & Thoracic Surgery, 2014, Vol 18, Issue suppl_1, pS21
- ISSN
1569-9293
- Publication type
Article
- DOI
10.1093/icvts/ivu167.80