Intraoperative transbronchial metallic coil marking guided by mobile 3D C-arm for resection of a small peripheral lung lesion

Sublober resection of small peripheral lung lesions using video-assisted thoracoscopic surgery may require marking and confirmation using 3D imaging in the interventional radiology suite or in the hybrid operating room (HOR) before surgery is started. We report a novel approach for intraoperative transbronchial metallic coil marking followed by thoracoscopic wedge resection in a conventional operating room under mobile 3D C-arm guidance. Under general anesthesia, an ultrathin video-bronchoscope was inserted into an objective bronchus guided with virtual bronchoscopic navigation, and a coil-feeding microcatheter was introduced through the bronchoscope's channel. After the position of the catheter tip was confirmed with cone-beam computed tomography (CT) images rendered via a mobile 3D C-arm, a metallic coil was subsequently deployed through the catheter as a marker. During surgery, the nodule with the metallic coil was grasped with pulmonary forceps and fully resected with endostaplers under fluoroscopic guidance. This method has advantages because the transbronchial approach carries a lower risk of complications such as pneumothorax and air embolism compared with a percutaneous approach, and the metallic coil provides more accurate, pinpoint localization compared with liquid dye. Mobile 3D C-arm-guided transbronchial metallic coil marking followed by thoracoscopic wedge resection under fluoroscopic guidance is a one-stop solution for intraoperative marking and resection of small peripheral pulmonary lesions in any operating room.