Clinical Scorecard: Enhancing Sensory Awareness: Utilizing Intraoperative Lung Ultrasound for Accurate Localization of Pulmonary Nodules in Robotic Thoracic Surgery

At a Glance

Key Highlights

• ILU achieves high detection rates (up to 100%) for non-palpable, deep pulmonary nodules during minimally invasive thoracic surgery.
• ILU reduces localization and operative times compared to manual palpation techniques.
• ILU is a safe, real-time, non-invasive alternative to preoperative localization methods that carry risks such as pneumothorax and hemorrhage.

Guideline-Based Recommendations

Diagnosis

• Use ILU intraoperatively to localize solid or part-solid pulmonary nodules >1 cm from pleural surface during RATS.
• Exclude patients with pure ground-glass opacities, superficially located nodules (≤1 cm), or contraindications to single-lung ventilation.

Management

• Perform robotic anatomical lung resection or wedge resection guided by ILU findings.
• Utilize a linear ultrasound probe with abdominal preset, gain at 70%, and depth 50–60 mm for optimal nodule visualization.
• Ensure assistant surgeon controlling ultrasound probe is trained in lung ultrasound techniques.

Monitoring & Follow-up

• Monitor for intra- and post-operative complications related to nodule localization and resection.
• Assess resection margin adequacy intraoperatively following ILU-guided localization.

Risks

• ILU is associated with minimal procedural risks compared to preoperative localization techniques such as CT-guided hook-wire placement.
• Avoid ILU in patients with severe emphysema impairing lung deflation or contraindications to single-lung ventilation.

Patient & Prescribing Data

Adults undergoing robotic thoracic surgery for suspicious pulmonary nodules without prior histological diagnosis

ILU facilitates accurate intraoperative localization, enabling precise resection with reduced operative time and minimal complications

Clinical Best Practices

• Select patients carefully based on nodule characteristics and surgical suitability to maximize ILU effectiveness.
• Train surgical assistants in lung ultrasound to optimize probe handling and image interpretation during RATS.
• Use sterile sheaths and acoustic gel on the ultrasound probe to maintain sterility and image quality.
• Position patients in lateral decubitus with single-lung ventilation to facilitate lung collapse and ultrasound scanning.
• Incorporate ILU as a complementary tool to robotic visualization to overcome the lack of tactile feedback.

References

• Minimally invasive thoracic surgery benefits
• Robotic-assisted thoracic surgery advantages and limitations
• Preoperative localization techniques and complications
• Intraoperative lung ultrasound in thoracic surgery
• ILU detection rates and operative time benefits
• Feasibility of ILU in robotic thoracic surgery