Techniques for Perioperative Localization of Pulmonary Nodules for Precision Resection in VATS and Robot-Assisted Thoracoscopic Surgery: An Overview
摘要
Accurate localization of pulmonary nodules is essential for precise sublobar resections in VATS and robot-assisted thoracoscopic surgery. The approach used for localization of these nodules until recently was largely by CT-guided percutaneous route or bronchoscopy-aided transbronchial methods. The markers can be metallic, such as hookwires, microcoils, fiducial agents or liquid markers like blue dyes, indocyanine green (ICG), radiocontrast agents, medical glue, radioisotopes and molecular agents. Recently, systemic injection of fluorescent dyes, like ICG, coupled with near-infrared imaging is revolutionizing resection surgery of pulmonary nodules, as it decreases the chances of complications like pneumothorax, and pulmonary haemorrhage seen in traditional localization techniques and obviates the need for fluoroscopy, thereby decreasing radiation exposure. Other routes of administration, like use of inhalational ICG, are also being investigated. Some of the innovative emerging methodologies include electromagnetic navigation and transthoracic localization, robot-assisted navigation technologies, hybrid operating room with cone beam CT, 3D printing, and virtual-assisted lung mapping. This chapter is an overview of the various approaches available for localizing pulmonary nodules, the technique, the markers used and the outcomes with special reference to commonly used liquid markers like methylene blue, ICG, and radioisotopes.