Massachusetts Chapter of the American College of Surgeons

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Navigational Bronchoscopy for Localization of Small Lung Nodules: A Novel Approach To Simultaneous Nodule Localization and Resection
Patrick Craft, Kelsey Baran, Christian Padilla-Galvez
Berkshire Medical Center- Department of Surgery

Background: The initiative to identify early lung cancer has led to recognition of nodules that are challenging to localize for diagnosis and resection. In our institution we are incorporating intraoperative electromagnetic navigational bronchoscopy(ENB) with endoscopic marker placement and simultaneous robotic-resection. We aimed to evaluate the impact on time-to-diagnosis, time-to-surgery and LOS.
Methods:Retrospective review of all patients who underwent nodule localization and VATS or robotic-assisted VATS (RA-VATS) between 5/2011 and 3/2019. ENB localization was performed with transbronchial injection/placement of ICG/fidicual-markers.
Results:72 patients underwent(VATS/RA-VATS). During first two years, ENB was performed with C-arm-fluoroscopic guidance with diagnostic-yield of 48%. Surgery performed at 29.7 days on average(4-190 days) after ENB(3 patients followed with serial CT-imaging). In August-2017, utilization of cone-beam-CT(CBCT) began during ENB with time to surgery(TTS) reduced, to average 20.1 days(1-39). After persistent low-diagnostic yield with bronchoscopy, in February-2018, ENB and surgical resection was performed simultaneously with single anesthetic administration and OR-team. In December-2018, the daVinci-Xi was utilized for RA-VATS with ICG-injection during ENB for nodule localization. The LOS and TTS (from the initial identification of a lung nodule to surgery) for Super-D-Bronchoscopy group(SDB)(n=36) was 6.7/63.8 days, SDB-with CBCT(n=8) was 5.5/62.8 days. Additional day LOS added for required bronchoscopy. Transition to simultaneous resection(n=28) resulted in 100% diagnostic yield, further decrease of both hospital LOS/TTS, to 3.6 days and 43.7 days.
Conclusion:Our data demonstrates that intraoperative ENB lung lesion localization with simultaneous VATS/RATS resection results in decreased hospital length of stay, reduced time to treatment, and 100% diagnostic yield. Both metrics significantly impact patient satisfaction and healthcare costs.


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