Hybrid operating room for the intraoperative CT-guided localization of pulmonary nodules

Abstract

Video-assisted thoracic surgery (VATS) requires preoperative computed tomography (CT)-guided localization of small pulmonary nodules or ground glass opacities (GGOs). However, this traditional two-stage approach is not devoid of potential complications, including wire dislodgement, pneumothorax, and/or hemothorax. With the advent of hybrid operating rooms (HORs), simultaneous single-stage localization and removal of such lesions has become possible. Here, we review the technical developments and the state-of-the-art in the field of intraoperative CT-guided localization and resection of small pulmonary nodules performed within a HOR.

Keywords: Ground glass opacities (GGOs); hybrid operating room (HOR); intraoperative computed tomography-guided localization (IOCT-guided localization); video-assisted thoracic surgery (VATS).

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1

Procedural workflow of pulmonary lesion localization in a hybrid operating room. (A) Initial scanning: the patient should be positioned according to lesion localization, with supine, lateral decubitus, modified semiprone, or semisupine positions being all potentially suitable. Notably, the anesthesia workstation pipelines should be gathered and aligned within the table edge to avoid any potential entanglement with the C-arm during CBCT rotation; (B) needle path planning: after an initial scan, the localization path should be planned on the CT image via the syngo Needle Guidance of a syngo X-Workplace (Siemens Healthcare GmbH); (C) laser-guided needle puncture: a laser beam that marks both the needle entry point and the proper angle for needle path should be projected from the C-arm onto the patient’s skin. The marker needle is thus placed under laser guidance; (D) thoracoscopic view of the near-infrared “tattoo” on the lung surface, which was used to guide lung resection.