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A single-center experience of 100 image-guided video-assisted thoracoscopic surgery procedures.

Background
The advent of image-guided video-assisted thoracoscopic surgery (iVATS) has allowed the simultaneous localization and removal of small lung nodules. The aim of this study is to detail, in a retrospective review, one institution's experience using iVATS in this clinical setting, with a special attention to efficacy, safety, and procedural details.


Methods
This study was a retrospective analysis of prospectively collected data. Between October 2016 and January 2018, a total of 95 patients with 100 small lung nodules underwent iVATS. All procedures were performed in a hybrid operating room (HOR) in which a cone-beam computed tomography (CT) apparatus and a laser navigation system were present.


Results
The mean size of the 100 lung nodules was 7.94 mm, with their mean depth from the visceral pleura being 10 mm. A total of 98 nodules were successfully localized; of them, 94 were resected through a marker-guided procedure. There were four resection failures [wire dislodgement (n=2) or dye spillage (n=2)]). A significant inverse association was found between localization time (mean: 21.19 min) and the surgeon's experience (Pearson's r=-0.632; P<0.001). The mean length of hospital stay was 4.87 days and there were no perioperative deaths.


Conclusions
In the current context of an increase in early diagnosis of lung cancer by screening programs, iVATS performed in a HOR offers a safe and efficient option for simultaneous localization and removal of small pulmonary nodules.