title: Thoracoscopic localization of intraparenchymal pulmonary nodules using direct intracavitary thoracoscopic ultrasonography prevents conversion of VATS procedures to thoracotomy in selected patients.
abstract: OBJECTIVE
  To investigate the feasibility, accuracy, and effect on conversion rates of intracavitary video-assisted thoracoscopic surgery ultrasonography (VATS-US) for localization of difficult to visualize pulmonary nodules.
  
  
  METHODS
  The study consisted of a prospective cohort of VATS-US for localization of intraparenchymal peripheral pulmonary nodules. Patients with pulmonary nodules not touching the visceral pleura on the computed tomography scan, who were scheduled for VATS wedge resection, were prospectively enrolled. The lobe of interest was examined: visually, using finger palpation when possible, and using the instrument sliding method. The nodule was then sought using a sterile ultrasound transducer. The primary outcome measure was the prevention of conversion to thoracotomy or lobectomy secondary to positive VATS-US findings in patients with nodules that were not identifiable using standard VATS techniques.
  
  
  RESULTS
  Four different surgeons performed 45 individual VATS-US procedures during a 13-month period. Intracavitary VATS-US was able to detect 43 of 46 nodules. The sensitivity of VATS-US was 93%, and the positive predictive value was 100%. The lung nodules were visualized by thoracoscopic lung examination in 12 cases (27%), palpable by finger in 18 cases (40%), and palpable using the instrument sliding technique in 17 cases (38%). In 20 cases, lung nodules were not identifiable using any of the traditional techniques and were identified only with VATS-US. VATS-US, therefore, prevented conversion to thoracotomy or lobectomy without tissue diagnosis in 43% (20/46) of cases.
  
  
  CONCLUSIONS
  Intracavitary VATS-US is a real-time, feasible, reliable, and effective method of localization of intraparenchymal pulmonary nodules during selected VATS wedge resection procedures and can decrease the conversion rates to thoracotomy or lobectomy.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, CHUM Endoscopic Tracheobronchial and Oesophageal Center, University of Montréal, Montréal, Québec, Canada.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Khereba
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ferraro
authors.forename: Andre
authors.initials: A
authors.lastname: Duranceau
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Martin
authors.forename: Eric
authors.initials: E
authors.lastname: Goudie
authors.forename: Vicky
authors.initials: V
authors.lastname: Thiffault
authors.forename: Moishe
authors.initials: M
authors.lastname: Liberman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging* / Q000601:surgery*; D010173:Palpation; D011013:Pneumonectomy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011792:Quebec; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D019564:Unnecessary Procedures