The feasibility of navigation bronchoscopy-guided pulmonary microcoil localization of small pulmonary nodules prior to thoracoscopic surgery

Junxiang Chen; Xufeng Pan; Chuanjia Gu; Xiaoxuan Zheng; Haibin Yuan; Jun Yang; Jiayuan Sun

doi:10.21037/tlcr-20-1206

The feasibility of navigation bronchoscopy-guided pulmonary microcoil localization of small pulmonary nodules prior to thoracoscopic surgery

Transl Lung Cancer Res. 2020 Dec;9(6):2380-2390. doi: 10.21037/tlcr-20-1206.

Authors

Junxiang Chen^{1

2

3}, Xufeng Pan⁴, Chuanjia Gu^{1

2

3}, Xiaoxuan Zheng^{1

2

3}, Haibin Yuan⁵, Jun Yang⁴, Jiayuan Sun^{1

2

3}

Affiliations

¹ Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
² Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
³ Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China.
⁴ Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
⁵ Department of Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.

Abstract

Background: Accurate preoperative localization of small pulmonary nodules facilitates the rapid and precise video-assisted thoracoscopic surgery (VATS). This study aims to evaluate the feasibility, safety, and efficacy of navigation bronchoscopy-guided pulmonary microcoil placement for preoperative pulmonary nodule localization.

Methods: Twelve lung lesions were simulated by mixing lipiodol in three porcine models. After 1 week, two microcoils per lesion were deployed under bronchoscopic guidance. Computed tomography scans were then performed 1 day, 1 week, 2 weeks, and 4 weeks after the deployment to assess the position of the microcoils relative to the lesions. Surgical resection of the simulated lesions was performed under fluoroscopy 5 weeks after the deployment and the accuracy, stability, and associated complications of the microcoil localization were evaluated. Following this, an exploratory clinical study was conducted on three patients with pure ground-glass pulmonary nodules.

Results: The mean diameter of the twelve simulated lung lesions was 9.55±2.36 mm, and the mean distance from the pleura to the lesions was 8.29±2.99 mm. Twenty-four pulmonary microcoils were implanted in the bronchi surrounding the lesions. Four weeks later, the mean distance between the microcoils and the center of the lesions was 16.12±8.97 mm and the average migration of the microcoils relative to the baseline position (1 day after implantation) was 3.48±4.56 mm. All microcoils and target lesions were successfully resected in both the animal experiment and clinical study and no complications, such as pneumothorax, were observed during marker implantation or postoperative follow-up.

Conclusions: The preoperative localization of pulmonary nodules by navigation bronchoscopy-guided microcoil placement is a safe, stable, and effective technique with minimal complication risk. This procedure can assist subsequent thoracoscopic resection.

Keywords: Pulmonary microcoil; navigation bronchoscopy; preoperative localization; pulmonary nodule; video-assisted thoracoscopic surgery (VATS).