title: Computed Tomography-Assisted Thoracoscopic Surgery: A Novel, Innovative Approach in Patients With Deep Intrapulmonary Lesions of Unknown Malignant Status.
abstract: Minimally invasive resection of small, deep intrapulmonary lesions can be challenging due to the difficulty of localizing them during video-assisted thoracoscopic surgery (VATS). We report our preliminary results evaluating the feasibility of an image-guided, minimally invasive, 1-stop-shop approach for the resection of small, deep intrapulmonary lesions in a hybrid operating room (OR).
  
  
  
  Fifteen patients (5 men, 10 women; mean age, 63 years) with a total of 16 solitary, deep intrapulmonary nodules of unknown malignant status were identified for intraoperative wire marking. Patients were placed on the operating table for resection by VATS. A marking wire was placed within the lesion under 3D laser and fluoroscopic guidance using a cone beam computed tomography system. Then, wedge resection by VATS was performed in the same setting without repositioning the patient.
  
  
  
  Complete resection with adequate safety margins was confirmed for all lesions. Marking wire placement facilitated resection in 15 of 16 lesions. Eleven lesions proved to be malignant, either primary or secondary; 5 were benign. Mean lesion size was 7.7 mm; mean distance to the pleural surface was 15.1 mm (mean lesion depth-diameter ratio, 2.2). Mean procedural time for marking wire placement was 35 minutes; mean VATS duration was 36 minutes.
  
  
  
  Computed tomography-assisted thoracoscopic surgery is a new, safe, and effective procedure for minimally invasive resection of small, deeply localized intrapulmonary lesions. The benefits of computed tomography-assisted thoracoscopic surgery are 1. One-stop-shop procedure, 2. Lower risk for the patient (no patient relocation, no marking wire loss), and 3. No need to coordinate scheduling between the CT room and OR.
authors.affiliation: From the *Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, †Fraunhofer Project Group for Automation in Medicine and Biotechnology, ‡Department of Anesthesia and Intensive Care Medicine, and §Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Kostrzewa
authors.forename: Kerim
authors.initials: K
authors.lastname: Kara
authors.forename: Nils
authors.initials: N
authors.lastname: Rathmann
authors.forename: Charalambos
authors.initials: C
authors.lastname: Tsagogiorgas
authors.forename: Thomas
authors.initials: T
authors.lastname: Henzler
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schoenberg
authors.forename: Peter
authors.initials: P
authors.lastname: Hohenberger
authors.forename: Steffen J
authors.initials: SJ
authors.lastname: Diehl
authors.forename: Eric D
authors.initials: ED
authors.lastname: Roessner
mesh_terms: D054893:Cone-Beam Computed Tomography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000601:surgery; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*