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|
| Nav Bronch
|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|