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J Thorac Cardiovasc Surg 2006;131:704-710
© 2006 The American Association for Thoracic Surgery

General Thoracic Surgery

Fluoroscopy-assisted thoracoscopic resection of pulmonary nodules after computed tomography–guided bronchoscopic metallic coil marking

Takanori Miyoshi, MD, PhD, Kazuya Kondo, MD, PhD * , Hiromitsu Takizawa, MD, Koichiro Kenzaki, MD, Haruhiko Fujino, MD, PhD, Shoji Sakiyama, MD, PhD, Akira Tangoku, MD, PhD

Department of Oncological and Regenerative Surgery, Institute of Health Biosciences, University of Tokushima Graduate School, Kuramoto-cho, Tokushima, Japan.

Received for publication May 2, 2005; revisions received September 5, 2005; accepted for publication September 15, 2005.

* Address for reprints: Kazuya Kondo, MD, Department of Oncological and Regenerative Surgery, Institute of Health Biosciences, University of Tokushima Graduate School, Kuramoto-cho, Tokushima 770-8503, Japan. (Email: kondo{at}clin.med.tokushima-u.ac.jp).

OBJECTIVE: To localize small and deeply situated pulmonary nodules during thoracoscopy with roentgenographic fluoroscopy, we developed a marking procedure that uses a metallic coil.

METHODS: Nine patients underwent video-assisted thoracoscopic surgery for the removal of 11 pulmonary lesions. Fluoroscopy-assisted thoracoscopic surgery after computed tomography-guided bronchoscopic metallic coil marking was performed with an ultrathin bronchoscope, with simulation by means of virtual bronchoscopy. During thoracoscopy, a C-arm–shaped roentgenographic fluoroscope was used to detect the radiopaque nodules.

RESULTS: The marking procedure took 15 to 60 minutes from insertion to removal of the bronchoscope. There were no complications from the marking, and all 11 nodules were easily localized by means of thoracoscopy. The metallic coil showed the nodules on the fluoroscopic monitor, which aided in nodule manipulation. Nodules were completely resected under thoracoscopic guidance, except in one case in which a minithoracotomy was performed at an early stage of the trial. The pathologic diagnosis was primary adenocarcinoma in 9 patients, pulmonary metastasis from colon cancer in 1 patient, and pulmonary lymph node in 1 patient. Two cases of bronchioloalveolar adenocarcinoma with an invasive component and a well-differentiated adenocarcinoma were converted to open thoracotomy to perform curative lobectomy.

CONCLUSIONS: In this pilot study computed tomography–guided transbronchial metallic coil marking with an ultrathin bronchoscope with virtual bronchoscopic simulation might be a useful method for the fluoroscopy-assisted thoracoscopic resection of pulmonary nodules.

Abbreviations and Acronyms CT = computed tomography; FATS-CM = fluoroscopy-assisted thoracoscopic surgery after CT-guided bronchoscopic metallic coil marking; VB = virtual bronchoscopy






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