Image‐guided video‐assisted thoracoscopic resection (iVATS): Translation to clinical practice—real‐world experience

• Published in: Journal of surgical oncology 2020-06, Vol.121 (8), p.1225-1232
• Main Authors: Gill, Ritu R., Barlow, Julianne, Jaklitsch, Michael T., Schmidlin, Eric J., Hartigan, Phillip M., Bueno, Raphael
• Format: Article
• Language: English
• Subjects: advanced image‐guided operating room; Clinical medicine; C‐arm CT; fiducials; hybrid operating room; Lung cancer; Surgical outcomes; Thoracic surgery; VATS
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.25897

Objective We developed a novel approach for localization and resection of lung nodules, using image‐guided video‐assisted thoracoscopic surgery (iVATS). We report our experience of translating iVATS into clinical care. Methods Methodology and workflow for iVATS developed as part of the Phase I/II trial were used to train surgeons, radiologists, anesthesiologists, and radiology technologists. Radiation dose, time from induction to incision, placement of T‐bar to incision and incision to closure, hospital stay, and complication rates were recorded. Results Fifty patients underwent iVATS for resection of 54 nodules in a clinical hybrid operating room (OR) by six surgeons. Fifty‐two (97%) nodules were successfully resected. Forty‐two (84%) patients underwent wedge resection, four (7%) lobectomies, and two (4%) segmentectomy all with lymph node dissection. Median time from induction to incision was 89 minutes (range: 13‐256 minutes); T‐bar placement was 14 minutes (10‐29 minutes); and incision to closure, 107 minutes (41‐302 minutes). Average and total procedure radiation dose were: median = 6 mSieverts (range: 2.9‐35 mSieverts). No deaths were reported and median length of stay was 3 days (range: 1‐12 days). Conclusions Translation of iVATS into clinical practice has been initiated using a safe step‐wise process, combining intraoperative C‐arm computed tomography scanning and thoracoscopic surgery in a hybrid OR.