Feasibility and Safety of CIOS Spin for One-Stop Pulmonary Nodule Localization and Resection

TL;DR

This study shows that a mobile 3D imaging system can safely and effectively locate and remove lung nodules in a single procedure.

Contribution

Demonstrates the first use of the Cios Spin system for integrated pulmonary nodule localization and resection.

Findings

100% technical success in preoperative localization of pulmonary nodules.

Only minor complications occurred, with all patients recovering uneventfully.

Procedure durations were within acceptable ranges for most patients.

Abstract

Ground-glass nodules (GGNs), early signs of lung adenocarcinoma, increasingly require minimally invasive diagnosis due to expanded health screening. This study evaluates the mobile 3-dimensional (3D) Cios Spin system (initially for orthopaedics) in achieving integrated localization and resection of pulmonary nodules.

This retrospective study analysed 23 consecutive patients who underwent thoracic procedures at the Department of Thoracic and Cardiovascular Surgery, Fourth Affiliated Hospital of Soochow University (Dushu Lake Hospital), from January to December 2023, based on electronic medical records and operative reports. Before surgery, all pulmonary nodules were identified via low-dose or non-contrast chest computed tomography (CT) and confirmed to persist over ≥3 months. The localization needle was precisely placed (needle within ≤5 mm of nodule margin confirmed intraoperatively) with no intraoperative dislodgment. Data collection focused on demographics, procedural details, and perioperative outcomes to evaluate the intervention’s feasibility and safety.

Preoperative localization achieved 100% technical success, defined as accurate placement of the localization needle within ≤5 mm of nodule margin confirmed intraoperatively. Periprocedural complications included one pneumothorax (4.3%) during needle insertion. Positioning exceeded 45 minutes in 2 patients (8.7%) due to anatomical/imaging limitations; 1 (4.3%) required unguided resection without adverse outcomes: Mean durations were 35.3 ± 6.4 minutes for localization and 90.8 ± 20.2 minutes for surgery. All patients recovered uneventfully. No recurrence occurred at 6-month follow-up, but 2-year follow-up is required to assess long-term efficacy (retrospective follow-up ongoing).

This case series supports the feasibility, safety, and clinical efficacy of combining pulmonary nodule localization and resection using the mobile 3D C-arm Cios Spin system. Device/patient factors (eg, system constraints) compromised localization in select cases, necessitating technical refinements and optimized selection criteria.

Emerging localization modalities incorporating image-guided technologies—including flexible trocar systems, microcoil deployment, and indocyanine green fluorescence marking—demonstrate improved safety profiles compared with conventional Hook-wire techniques,1–4 particularly enhancing bilateral pulmonary lesion targeting accuracy.

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