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2018-51) and informed consent was taken from all the patients.Īll patients underwent intravenous anesthesia with a laryngeal mask in the operating room. The study was approved by Ethics Commission of the First Affiliated Hospital of Guangzhou Medical University (No. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The cumulative sum (CUSUM) was used to investigate the in-depth learning curve of ENB localization. The inclusion criteria for ENB localization were: (I) patients with a suspicious malignant appearance in CT scan (GGO or semisolid) (II) nodules between 8–10 mm in diameter or more than 10 mm away from the pleura (III) presumed to be undetectable and unpalpable during VATS based on the surgeon’s experience.
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Among them, 64 patients with 89 ENB localizations, performed by a single thoracic surgeon (SBL) who has the experience of routine bronchoscopy and not the experience of endobronchial ultrasonography (EBUS) and ENB-guided biopsy, were finally included in the study as shown in Figure 1. We present the following article in accordance with the STROBE reporting checklist (available at ).Ī total of 129 patients underwent ENB to localize PNs between October 2018 and October 2019 at the First Affiliated Hospital of Guangzhou Medical University. In the study, we aimed to initially describe the learning curve of ENB-guided preoperative localization of PNs performed by a single surgeon from our center. However, there was no study to report the learning curve of ENB-guided preoperative localization. It also has significant advantages in localizing multiple lung nodules compared with the CT-guided method ( 10, 11). Meanwhile, this technique can be performed in an operating room without radiation exposure. Compared with the commonly used CT-guided transthoracic localization, the advent of ENB-guided localization can effectively decrease many complications, such as pneumothorax, hemorrhage, and embolism ( 9). Many studies have confirmed that ENB was a feasible and effective method for preoperative PN localization with a high success rate (91.4–97.2%) ( 4, 9). Recently, this technology was increasingly used to preoperatively mark small PNs due to high effectiveness and low risk ( 7, 8). The ENB was used in relatively large PN biopsy initially but with inferior diagnostic yield ( 6). However, the precise localization of some ground-glass opacity (GGO) or semisolid small pulmonary nodules (PNs) is challenging to thoracic surgeons during VATS, especially when the nodules are less than 10 mm in diameter or when they are more than 10 mm away from the pleura ( 4).Įlectromagnetic navigation bronchoscopy (ENB) is a navigation technology that converts two-dimensional preoperative computed tomographic (CT) imaging into a three-dimensional (3-D) virtual bronchial map and uses an electromagnetic board to guide the bronchoscopic probe to PN ( 5).
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This improvement in lung cancer early diagnosis has significantly reduced its mortalities through successfully video-assisted thoracic surgery (VATS) resection in its early stage ( 2, 3). With the advent of low-dose CT screening, early lung cancer can be detected effectively. Lung cancer is one of the most prevailing cancers and the leading cause of cancer-associated death worldwide ( 1).