Name: electromagnetic navigation transthoracic nodule localization for minimally invasive thoracic surgery
Uploaded: 2022-05-04T14:00:00
Description: Watch this Scientific Journal Video about Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery at JoVE.com

这项工作由T32HL007106-41（对Sohini Ghosh）提供支持。

该程序按照护理期望的标准进行，并遵循北卡罗来纳大学教堂山分校人类研究伦理委员会的指导方针。
1. 术前准备
<ol><li>回顾既往胸部计算机断层扫描 （CT） 成像，以确保接受结节定位的患者具有适合微创胸外科手术 （MITS） 的外周肺结节。</li>
	<li>在手术前一天或手术前一天，进行非造影性胸部CT扫描，患者处于侧卧位，肺与结节同侧向上定位，以模仿染料注射期间的位?...

<ol>
	<li>National Lung Screening Trial Research, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Results+of+initial+low-dose+computed+tomographic+screening+for+lung+cancer.">Results of initial low-dose computed tomographic screening for lung cancer.</a> The New England Journal of Medicine. 368 (21), 1980-1991 (2013).</li><li>Gould, M. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Recent+Trends+in+the+Identification+of+Incidental+Pulmonary+Nodules.">Recent Trends in the Identification of Incidental Pulmonary Nodules.</a> American Journal of Respiratory and Critical Care Medicine. 192 (10), 1208-1214 (2015).</li><li>Ng, Y. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=CT-guided+percutaneous+fine-needle+aspiration+biopsy+of+pulmonary+nodules+measuring+10+mm+or+less.">CT-guided percutaneous fine-needle aspiration biopsy of pulmonary nodules measuring 10 mm or less.</a> Clinical Radiology. 63 (3), 272-277 (2008).</li><li>Rocco, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+statement+on+the+role+of+the+surgeon+and+surgical+issues+relating+to+computed+tomography+screening+programs+for+lung+cancer.">Clinical statement on the role of the surgeon and surgical issues relating to computed tomography screening programs for lung cancer.</a> The Annals of Thoracic Surgery. 96 (1), 357-360 (2013).</li><li>Suzuki, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Video-assisted+thoracoscopic+surgery+for+small+indeterminate+pulmonary+nodules:+indications+for+preoperative+marking.">Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodules: indications for preoperative marking.</a> Chest. 115 (2), 563-568 (1999).</li><li>Libby, D. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Managing+the+small+pulmonary+nodule+discovered+by+CT.">Managing the small pulmonary nodule discovered by CT.</a> Chest. 125 (4), 1522-1529 (2004).</li><li>Arias, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+Electromagnetic+Navigational+Transthoracic+Needle+Aspiration+(E-TTNA)+for+Sampling+of+Lung+Nodules.">Use of Electromagnetic Navigational Transthoracic Needle Aspiration (E-TTNA) for Sampling of Lung Nodules.</a> Journal of Visualized Experiments. (99), e52723 (2015).</li><li>Wang Memoli, J. S., Nietert, P. J., Silvestri, G. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Meta-analysis+of+guided+bronchoscopy+for+the+evaluation+of+the+pulmonary+nodule.">Meta-analysis of guided bronchoscopy for the evaluation of the pulmonary nodule.</a> Chest. 142 (2), 385-393 (2012).</li><li>Khandhar, S. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Electromagnetic+navigation+bronchoscopy+to+access+lung+lesions+in+1,000+subjects:+first+results+of+the+prospective,+multicenter+NAVIGATE+study.">Electromagnetic navigation bronchoscopy to access lung lesions in 1,000 subjects: first results of the prospective, multicenter NAVIGATE study.</a> BMC Pulmonary Medicine. 17 (1), 59 (2017).</li><li>Munoz-Largacha, J. A., Ebright, M. I., Litle, V. R., Fernando, H. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Electromagnetic+navigational+bronchoscopy+with+dye+marking+for+identification+of+small+peripheral+lung+nodules+during+minimally+invasive+surgical+resection.">Electromagnetic navigational bronchoscopy with dye marking for identification of small peripheral lung nodules during minimally invasive surgical resection.</a> Journal of Thoracic Disease. 9 (3), 802-808 (2017).</li><li>Awais, O., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Electromagnetic+Navigation+Bronchoscopy-Guided+Dye+Marking+for+Thoracoscopic+Resection+of+Pulmonary+Nodules.">Electromagnetic Navigation Bronchoscopy-Guided Dye Marking for Thoracoscopic Resection of Pulmonary Nodules.</a> The Annals of Thoracic Surgery. 102 (1), 223-229 (2016).</li><li>Kamel, M., Stiles, B., Altorki, N. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+Issues+in+the+Surgical+Management+of+Screen-Identified+Lung+Cancers.">Clinical Issues in the Surgical Management of Screen-Identified Lung Cancers.</a> Oncology (Williston Park). 29 (12), 944-949 (2015).</li><li>Park, C. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparative+Effectiveness+and+Safety+of+Preoperative+Lung+Localization+for+Pulmonary+Nodules:+A+Systematic+Review+and+Meta-analysis.">Comparative Effectiveness and Safety of Preoperative Lung Localization for Pulmonary Nodules: A Systematic Review and Meta-analysis.</a> Chest. 151 (2), 316-328 (2017).</li><li>Kleedehn, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preoperative+Pulmonary+Nodule+Localization:+A+Comparison+of+Methylene+Blue+and+Hookwire+Techniques.">Preoperative Pulmonary Nodule Localization: A Comparison of Methylene Blue and Hookwire Techniques.</a> AJR. American Journal of Roentgenology. 207 (6), 1334-1339 (2016).</li><li>Keating, J., Singhal, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Novel+Methods+of+Intraoperative+Localization+and+Margin+Assessment+of+Pulmonary+Nodules.">Novel Methods of Intraoperative Localization and Margin Assessment of Pulmonary Nodules.</a> Seminars in Thoracic and Cardiovascular Surgery. 28 (1), 127-136 (2016).</li><li>Yang, S. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Image-guided+thoracoscopic+surgery+with+dye+localization+in+a+hybrid+operating+room.">Image-guided thoracoscopic surgery with dye localization in a hybrid operating room.</a> Journal of Thoracic Disease. 8, S681-S689 (2016).</li><li>Gill, R. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Image-guided+video+assisted+thoracoscopic+surgery+(iVATS)+-+phase+I-II+clinical+trial.">Image-guided video assisted thoracoscopic surgery (iVATS) - phase I-II clinical trial.</a> Journal of Surgical Oncology. 112 (1), 18-25 (2015).</li><li>Bolton, W. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Electromagnetic+Navigational+Bronchoscopy+Reduces+the+Time+Required+for+Localization+and+Resection+of+Lung+Nodules.">Electromagnetic Navigational Bronchoscopy Reduces the Time Required for Localization and Resection of Lung Nodules.</a> Innovations (Phila). 12 (5), 333-337 (2017).</li><li>Hartwig, M. G., D'Amico, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Thoracoscopic+lobectomy:+the+gold+standard+for+early-stage+lung+cancer?.">Thoracoscopic lobectomy: the gold standard for early-stage lung cancer?.</a> The Annals of Thoracic Surgery. 89 (6), S2098-S2101 (2010).</li><li>Veronesi, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic+lobectomy+and+segmentectomy+for+lung+cancer:+results+and+operating+technique.">Robotic lobectomy and segmentectomy for lung cancer: results and operating technique.</a> Journal of Thoracic Disease. 7 (Suppl 2), S122-S130 (2015).</li><li>Wei, B., Eldaif, S. M., Cerfolio, R. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic+Lung+Resection+for+Non-Small+Cell+Lung+Cancer.">Robotic Lung Resection for Non-Small Cell Lung Cancer.</a> Surgical Oncology Clinics of North America. 25 (3), 515-531 (2016).</li><li>Ninan, M., Dylewski, M. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Total+port-access+robot-assisted+pulmonary+lobectomy+without+utility+thoracotomy.">Total port-access robot-assisted pulmonary lobectomy without utility thoracotomy.</a> European Journal of Cardio-Thoracic Surgery. 38 (2), 231-232 (2010).</li><li>Veronesi, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Four-arm+robotic+lobectomy+for+the+treatment+of+early-stage+lung+cancer.">Four-arm robotic lobectomy for the treatment of early-stage lung cancer.</a> The Journal of Thoracic and Cardiovascular Surgery. 140 (1), 19-25 (2010).</li><li>Dhillon, S. S., Harris, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bronchoscopy+for+the+diagnosis+of+peripheral+lung+lesions.">Bronchoscopy for the diagnosis of peripheral lung lesions.</a> Journal of Thoracic Disease. 9 (Suppl 10), S1047-S1058 (2017).</li></ol>

EMN指导下的围手术期经胸结节定位是最近推出的EMN平台的新应用。EMTTNL性能的关键步骤是设备的正确点云配准以及对经皮插入部位和针头角度的关注。在 CT 扫描的多个平面（HUD、斜 90 和斜面）上可视化和维护进入角度对于手术的成功至关重要。
由于经常发生的故障排除问题，以下一些修改已进行了调整。对该技术的一项修改包括在侧卧位而不是仰卧位进行CT。由于患者明显?...

随着越来越多地使用胸部 CT 扫描进行诊断和筛查1，需要诊断评估的亚厘米级肺结节的检测量增加2。经皮和/或经支气管活检已成功用于对不确定和高危结节进行采样。这些病变由于其远端实质位置和小尺寸而经常成为具有挑战性的目标3。当有指征时，应 通过 微创胸外科手术（MITS）（例如视频或机器人辅助胸腔镜手术（VATS/RATS））进行保留肺切除术，对这些病变进行手术切除4。即使手术技术的进步，尽管在 MITS 期间直接显示肺实质，但术中切除仍存在挑战。这些挑战主要与结节定位困难有关，尤其是毛玻璃/半固体结节、亚厘米病变以及距离内脏胸膜超过 2 cm 的结节5，6。由于在手术过程中触觉反馈的丧失，这些挑战在 MITS 期间会加剧，并可能导致更具侵入性的手术方法，包括诊断性肺叶切除术和/或开胸切开术5。术中结核定位的许多问题可以通过 使用电磁 导航（EMN）和/或CT引导定位（CTGL）的辅助结核定位方法来缓解。该协议将首先强调使用电磁经胸结核定位（EMTTNL）的好处。其次，它将逐步描述如何在MITS之前复制该过程。
电磁导航通过将传感器技术与射线照相图像重叠来帮助靶向外周肺部病变。EMN首先包括使用可用的软件将气道和实质的CT图像转换为虚拟路线图。然后，患者的胸部被电磁（EM）场包围，在该场中检测到感觉导轨的确切位置。当将引导器械（例如，磁导航[MN]跟踪针）放置在患者的EM场（支气管内树或皮肤表面）内时，该位置叠加在虚拟路线图上，允许导航到软件上识别的目标病变。EMN 可通过经胸针入路或支气管镜检查进行。EMN支气管镜检查以前曾被描述用于活检和基准/染料定位7，8，9，10，11。已经开发了许多其他定位技术，成功率各不相同，包括 CT 引导基准放置、CT 引导下注射染料或放射性示踪剂、术中超声定位和 EMN 支气管镜检查12。最近推出的EMN平台已将电磁引导的经胸方法纳入其工作流程。使用CT路线图，该系统允许用户在胸壁表面上定义一个入口点，通过该入口，他们将通过尖端跟踪的EMN感针导进入肺实质和病变。通过该针头导轨，可以进行活检和/或结节定位7。
在MITS结节的EMN定位之前，使用染料标记或基准（例如，微线圈，脂状体，钩丝）放置的CTGL是采用的主要方法。最近对46项基准点定位研究的荟萃分析显示，所有三种基准点的成功率都很高;然而，气胸、肺出血和基准标志物脱落仍然是重要的并发症13。使用亚甲蓝进行 CT 引导示踪剂注射的成功率相似，但与钩线基准放置相比，并发症较少14。使用染料定位肺结节的主要限制之一是随时间推移的扩散15。接受带有染料标记的CTGL的患者在放射科套件中进行定位，然后运送到手术室，在此期间可能发生染料扩散，使该技术的吸引力降低。一些中心通过使用带有机器人C型臂CT的混合手术室来缓解这种时间流逝16，17;然而，重复图像和使用荧光透视仪15可能会增加辐射暴露。使用 EMN 支气管镜检查可进行围手术期结节定位。然而，这一直受到支气管镜检查时间延长以及无法在没有气道通路的情况下导航到这些病变的困扰。EMTTNL 允许在一个位置（即手术室）进行快速经皮结节定位，然后进行 MITS，从而减少定位和手术之间的时间18。除了EMN支气管镜检查外，Arias 等人。 描述使用EMN进行经皮活检7。下文将介绍这一程序对结核定位的调整。
一名79岁男性有40包年烟草使用史和膀胱癌，通过监测成像发现左下叶有一个新的PET氟去氧葡萄糖嗜血肺结节，大小为1.0 cm x 1.1 cm（图1）。鉴于病变的大小和位置，楔形切除术被认为是具有挑战性的，患者的肺储备使他不太适合诊断性肺叶切除术。决定他将接受EMTTNL以帮助MITS切除肺结节。

<table>
	<tbody>
		<tr>
			<td>Computed Tomography Scanner</td>
			<td></td>
			<td></td>
			<td>64 - detector (or greater) CT scanner</td>
		</tr>
		<tr>
			<td>SPiN Thoracic Navigation System</td>
			<td>Veran Medical Tecnologies</td>
			<td>SYS 4000</td>
			<td></td>
		</tr>
		<tr>
			<td>SPiN Planning Laptop Workstation</td>
			<td>Veran Medical Tecnologies</td>
			<td>SYS-0185</td>
			<td></td>
		</tr>
		<tr>
			<td>SPiN View Console</td>
			<td>Veran Medical Tecnologies</td>
			<td>SYS-1500</td>
			<td></td>
		</tr>
		<tr>
			<td>Always-On Tip Tracked Steerable Catheter</td>
			<td>Veran Medical Tecnologies</td>
			<td>INS-0322</td>
			<td>3.2 mm OD, 2.0 mm WC</td>
		</tr>
		<tr>
			<td>View Optical Probe</td>
			<td>Veran Medical Tecnologies</td>
			<td>INS-5500</td>
			<td></td>
		</tr>
		<tr>
			<td>vPAD2 Cable</td>
			<td>Veran Medical Techologies</td>
			<td>INS-0048</td>
			<td></td>
		</tr>
		<tr>
			<td>vPAD2 Patient Tracker</td>
			<td>Veran Medical Techologies</td>
			<td>INS-0050</td>
			<td></td>
		</tr>
		<tr>
			<td>SPiNPerc Biopsy Needle Guide Kit</td>
			<td>Veran Medical Techologies</td>
			<td>INS-5600</td>
			<td>Includes INS 5029 (Box of 5)</td>
		</tr>
		<tr>
			<td>ChloraPrep applicator</td>
			<td>Beckton Dickinson</td>
			<td>260815</td>
			<td>26 mL applicator (orange)</td>
		</tr>
		<tr>
			<td>Provay/Methylene Blue</td>
			<td>Cenexi/American Regent</td>
			<td>0517-0374-05</td>
			<td>50 mg/10 mL</td>
		</tr>
		<tr>
			<td>Sterile gloves</td>
			<td>Cardinal Health</td>
			<td>2D72PLXXX</td>
			<td></td>
		</tr>
		<tr>
			<td>Blue X-Ray O.R. Towels</td>
			<td>MedLine</td>
			<td>MDT2168204XR</td>
			<td></td>
		</tr>
		<tr>
			<td>Scope Catheter</td>
			<td>DSC</td>
			<td></td>
			<td>3.2 mm outer diameter, working channel 2.0</td>
		</tr>
	</tbody>
</table>

electromagnetic navigation transthoracic nodule localization for minimally invasive thoracic surgery

胸部计算机断层扫描 （CT） 的使用增加导致需要诊断评估和/或切除的肺结节检测增加。这些结节中的许多 是通过微创 胸外科手术识别和切除的;然而，亚厘米和亚固体结节通常难以在术中识别。这可以通过使用电磁胸间针定位来缓解。该协议描述了从术前到术后阶段的电磁定位的分步过程，并且是Arias等人先前描述的电磁引导经皮活检的改编 。 术前步骤包括当天获得CT，然后生成肺部的三维虚拟地图。从此地图中，选择目标病变和入口部位。在手术室中，然后用患者和电磁导航平台校准肺部的虚拟重建。然后将患者镇静，插管，并置于侧卧位。使用无菌技术和从多个视图进行可视化，将针头插入前选择皮肤入口部位的胸壁中，并向下驱动到目标病变。然后将染料注射到病变中，然后在拔针期间连续注射，在术中形成用于可视化的束。与CT引导定位相比，这种方法具有许多潜在的好处，包括减少辐射暴露和减少染料注射和手术之间的时间。染料从该途径扩散随着时间的推移而发生，从而限制了术中结节的识别。通过减少手术时间，患者等待时间减少，染料扩散时间减少，从而改善结节定位。与电磁支气管镜检查相比，气道结构不再是局限性，因为目标结节 是通过 透明质入路进入的。此过程的详细信息以分步方式进行描述。

患者是按照上述方案准备的。在此之后，通过注射总共1mL的1：1亚甲基蓝色：患者血液混合物进行EMTTNL。取出针头后，患者被准备并覆盖了MITS。机器人辅助胸外科手术使用四臂技术进行，机器人手术系统使用五个端口。使用一个12 mm机器人吻合端口（大多数前端口）和三个8mm机器人端口，沿着第八个肋间空间（每个9厘米）从锁骨中线向前延伸至肩胛骨尖端，沿第八肋间空?...

Watch this Scientific Journal Video about Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery at JoVE.com

Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery

这里介绍的是肺结节定位方案， 通过电磁导航 的经胸针进入使用染料标记。这里描述的技术可以在围手术期完成，以优化结节定位，并在进行微创胸外科手术时成功切除。

电磁导航经胸结节定位用于微创胸外科手术

The increased use of chest computed tomography (CT) has led to an increased detection of pulmonary nodules requiring diagnostic evaluation and/or ...

该技术的主要优点是，它有助于在微创肺切除术期间定位小的、深的和/或亚固体的肺结节。在开始手术之前，回顾先前的胸部计算机断层扫描或 CT 成像，以确保接受结节定位的患者具有适合微创胸外科手术的外周肺结节。然后进行非造影剂胸部 CT 扫描，患者处于侧卧位，肺与结节同侧向上定位，以模拟染料注射期间的位置。获取呼气和吸气图像，以解释结节运动。在手术当天，使用导航系统规划软件以数字方式分割目标病变。如果目标病变本质上是放射学纯毛玻璃，则分割软件可能无法正确识别病变。如果是这种情况，请在目标病变的中心放置一个虚拟目标。一旦成功标记了目标病变，使用计划软件描绘出用于穿刺进入的经皮部位。当患者处于侧卧位时，将同侧胸壁上的三个电子参考点垫连接到结节上，距离所选入口点至少五厘米。将焊盘插入电磁导航系统，并将电磁导航场发生器放置在参考焊盘上，以在系统中登记患者。然后使用电磁导航系统提供的提示对校准进行微调。场发生器就位后，使用电磁导航跨胸结核定位平台拍摄参考焊盘的虚拟快照。为了生成描述主气道范围的数据点云，首先将专有的电磁导航束一次性示波器导管插入双腔气管管的右腔中。将导管对准主胭膜，然后缓慢拉回气管，直到系统提示停止。然后将一次性示波器导管插入右下肺叶，直到提示停止另一个绿色复选标记。一旦数据点收集停止，将一次性示波器导管从双腔气管插管的右肺腔转移到管子左肺腔的导管中。然后将一次性范围导管驱动到左主干支气管近端两到三厘米处，分叉到左上叶和下叶。恢复数据收集，将一次性示波器导管驱动到左下叶，直到提示停止。一旦收集了完整的数据点云，使用电磁导航平台在胸壁皮肤入口部位对准一根经皮针进行引导。在胸腔入口点处标记皮肤，注意入口点刚好高于肋骨，并避免任何已知的脉管系统或骨结构。用2%氯己定溶液清洁皮肤至少15秒，让溶液干燥至少30秒。使用无菌技术覆盖场地，戴上无菌手套和无菌礼服。皮下注射1至2毫升1%利多卡因，用于局部麻醉。使用10号刀片手术刀在通过表皮的入口部位做一个5毫米的浅表皮肤切口。将无菌的19号电磁针放在标记的入口点上。使用电磁系统屏幕上的横向和日冕视图来调整进入角度，使其与目标病变的中心对齐。一旦确认了进入角度，将电磁导航道针固定在胸壁上。将针头牢固地穿过胸壁，同时麻醉小组将患者呼气。至关重要的是，操作员在电磁导航系统提供的三个视图中的至少两个视图中将针头与目标病变正确对齐，然后以直向下的推力稳定和推进针头。从胸壁到达目标病变的远端后，取出束样式并用手指覆盖针毂，不要移开针头。接下来，将含有2至3毫升适当浓度亚甲蓝的注射器连接到针头上，并将0.5毫升溶液注射到目标病变中。然后逐渐连续地沉积另外0.5毫升的溶液，同时缓慢地抽出针头以形成轨迹。当所有染料都已送达后，使用染料标记通过微创胸外科手术定位和切除肺结节。在刚才演示的电磁导航经胸结节定位后，可以在放气的肺中识别定位染料标记，并且可以进行诊断性楔形切除术。在尝试此过程时，重要的是要记住确保正确的注册和针胸壁放置。该技术有望为使用微创手术方法改善小结节切除术铺平道路，并探索该方法对诊断性肺叶切除术和/或转换为开胸术的速度的影响。

Research

JoVE Journal

Medicine

Minimally Invasive Establishment of Murine Orthotopic Bladder Xenografts

微创建立小鼠原位膀胱移植瘤的

Orthotopic bladder cancer xenografts are the gold standard to study molecular cellular manipulations and new therapeutic agents&#160;in vivo. Suitable ...

科研

医学

Use of Electromagnetic Navigational Transthoracic Needle Aspiration (E-TTNA) for Sampling of Lung Nodules

Use of Electromagnetic Navigational Transthoracic Needle Aspiration E-TTNA for Sampling of Lung Nodules

用于肺内结节样利用电磁导航肺穿刺抽吸术（E-TTNA）的

Lung nodule evaluation represents a clinical challenge especially in patients with intermediate risk for malignancy. Multiple technologies are presently ...

Encapsulation Thermogenic Preadipocytes for Transplantation into Adipose Tissue Depots

封装产热前脂肪细胞移植到脂肪组织仓库

Cell encapsulation was developed to entrap viable cells within semi-permeable membranes. The engrafted encapsulated cells can exchange low molecular ...

An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery

微创拇外翻手术中神经风险的解剖学研究

The growing popularity of minimally invasive surgical (MIS) procedures makes it necessary that new anatomical references arise, to aid in tridimensional ...

A Minimally Invasive Model to Analyze Endochondral Fracture Healing in Mice Under Standardized Biomechanical Conditions

标准化生物力学条件下小鼠软骨骨折愈合的微创模型分析

Bone healing models are necessary to analyze the complex mechanisms of fracture healing to improve clinical fracture treatment. During the last decade, an ...

Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation

内镜下鼻中隔成形术有限双线切除: 间隔偏差微创手术

Endoscopic septoplasty is a surgical procedure in otolaryngology that is commonly performed to treat nasal airway obstruction caused by nasal septal ...

Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion

锥形束术中计算机断层扫描图像指南,用于微创跨体间融合

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. ...

Absorbent Microbiopsy Sampling and RNA Extraction for Minimally Invasive, Simultaneous Blood and Skin Analysis

吸收性微活检取样和 rna 提取用于微创同时进行血液和皮肤分析

Conventional skin biopsy limits the clinical research that involves cosmetically sensitive areas or pediatric applications due to its invasiveness. Here, ...

Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome

经腋窝第一肋骨切除术治疗胸廓出口综合征

Thoracic outlet syndrome (TOS) is a common disorder that causes a significant loss of productivity. The transaxillary first rib resection (TFRR) protocol ...

A Pre-clinical Rat Model for the Study of Ischemia-reperfusion Injury in Reconstructive Microsurgery

重建显微外科缺血再灌注损伤研究的临床前大鼠模型

Ischemia-reperfusion injury is the main cause of flap failure in reconstructive microsurgery. The rat is the preferred preclinical animal model in many ...