Eastern Cardiothoracic Surgical Society

Electromagnetic Navigational Bronchoscopy Reduces the Time Required for Localization and Resection of Lung Nodules
William D. Bolton, Thomas Cochrane, Andrew Binks, James Stephenson, Allison Hale, Sharon Ben-Or. Greenville Health System, Piedmont, SC USA.


Objective: To evaluate Electromagnetic navigational bronchoscopy (ENB) and CT-guided placement as localization techniques for minimally invasive resection of small pulmonary nodules and determine if ENB is a safer and more effective method than CT-guided localization.

Methods: We performed a retrospective review of our thoracic surgery database to identify patients who underwent minimally invasive resection for a pulmonary mass and utilized either ENB or CT-guided localization techniques between July 2011 and May 2013.

Results: 383 patients had a minimally invasive resection during our study period, 50 of whom underwent ENB or CT localization (ENB = 25; CT = 25). There was no significant difference between CT and ENB patient groups in regards to age, gender, race, pathology, nodule size, or location. Both CT and ENB were 100% successful at localizing the mass and there was no difference in the type of definitive surgical resection (wedge, segmentectomy, or lobectomy) (p=0.320). Post-operative complications occurred in 36% of all patients, but there was no significant difference in the frequency or type of complication (P = 0.552). In terms of localization time and surgical time, there was no difference between groups. However, the down time between localization and resection was significant (CT = 190mins; ENB = 24mins)(Table SA19-1); this explains why the difference in Total time (sum of localization, down, and surgery) was significant (P < 0.001).

Conclusions: We found ENB to be as safe and effective as CT-guided wire placement, and to provide a significantly decreased down time between localization and surgical resection.

Table 1 – Localization times by procedure
Times

   Nav Bronch

Cat Scan

p-value

Localization Time    28.2 24.56 0.218
Patient Down Time    24.36 189.72 <0.001
Surgeon Wait Time    52.56 52.04 0.883
Loc Time to Surg. Start    52.56 214.28 <0.001
Operative room time    218.68 203.08 0.558