title: Fluoroscopy-assisted thoracoscopic resection after computed tomography-guided bronchoscopic metallic coil marking for small peripheral pulmonary lesions.
abstract: OBJECTIVE
  To re-evaluate the efficacy of fluoroscopy-assisted thoracoscopic resection after computed tomography (CT)-guided bronchoscopic metallic coil marking (FATS-CM), which was our original method for small peripheral pulmonary lesions.
  
  
  METHODS
  Fifty-eight patients with 63 lesions underwent FATS-CM. A metallic coil was installed in the bronchus nearest to the lesion under CT fluoroscopic guidance with ultrathin bronchoscopy. The virtual bronchoscopic navigation (VBN) system was used in 14 cases. Afterwards, we basically performed wide wedge resection (WWR) using a C-arm-shaped roentgenographic fluoroscope during thoracoscopic surgery initially, and then the final procedure was determined by intraoperative histological diagnosis. Moreover, we prospectively treated ground-glass opacity (GGO) lesions of <20 mm diameter according to our treatment protocol from September 2004.
  
  
  RESULTS
  We could install coils in the objective bronchi in all cases. The average time required for the marking procedure was 38.9 (15-120) min. Pneumothorax was recognized in 1 (1.7%) case as a complication, but no fatal complications occurred. We could also install coils for each lesion in 4 cases (9 lesions) with multiple lesions. In 14 cases with the VBN system, the examination time and CT number were significantly reduced (P < 0.05 and <0.001, respectively), compared with those of 40 cases without the VBN system. The average interval between the CM and the operation was 5.6 (0-30) days. We never experienced a case of migration preoperatively. Sixty-two (98.4%) lesions were definitively identified, and WWRs were performed using three trocars in 58 (92.1%) cases during thoracoscopic surgery. Lobectomy was initially performed in only 1 case owing to coil migration. Thirty-seven of 40 cases (92.5%) were in line with the treatment protocol. There were no local-regional recurrences in all cases undergoing WWR.
  
  
  CONCLUSIONS
  We could prospectively show that our method was suitable to perform WWR with a sufficient margin for small GGO lesions of <20 mm. Moreover, we reconfirmed that the advantages of our method were safety, permitting flexibility in scheduling operations and a high ability to deal with multiple lesions. Additionally, our method became a minimally invasive and mature technique by using a new VBN system.
authors.affiliation: Department of Thoracic and Endocrine Surgery and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan. andrea.zuin@unipd.it
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Toba
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kondo
authors.forename: Takanori
authors.initials: T
authors.lastname: Miyoshi
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kajiura
authors.forename: Mitsuteru
authors.initials: M
authors.lastname: Yoshida
authors.forename: Yukikiyo
authors.initials: Y
authors.lastname: Kawakami
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Takizawa
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kenzaki
authors.forename: Shoji
authors.initials: S
authors.lastname: Sakiyama
authors.forename: Akira
authors.initials: A
authors.lastname: Tangoku
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000379:methods*; D020000:Decision Support Systems, Clinical; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011446:Prospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome
keywords: Bronchoscopy; Computed tomography; Small peripheral lung cancer; Video-assisted thoracic surgery