{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T10:36:47Z","timestamp":1762079807191,"version":"3.40.5"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2021,11,3]],"date-time":"2021-11-03T00:00:00Z","timestamp":1635897600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>Thoracic surgeons are currently asked to resect smaller and deeper lesions which are difficult to detect thoracoscopically. The growing number of those lesions arises both from lung cancer screening programs and from follow-up of extrathoracic malignancies. This study analyzed the routine use of a CT-aided thoracoscopic approach to small pulmonary nodules in the hybrid theatre and the resulting changes in the treatment pathway.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>50 patients were retrospectively included. The clinical indication for histological diagnosis was suspected metastasis in 46 patients. Technically, the radiological distance between the periphery of the lesion and the visceral pleura had to exceed the maximum diameter of the lesion for the patient to be included. A spiral wire was placed using intraoperative CT-based laser navigation to guide the thoracoscopic resection.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The mean diameter of the lesions was 8.4 mm (SD 4.27 mm). 29.4 minutes (SD 28.5) were required on average for the wire placement and 42.3 minutes (SD 20.1) for the resection of the lesion. Histopathology confirmed the expected diagnosis in 30 of 52 lesions. In the remaining 22 lesions, 9 cases of primary lung cancer were detected while 12 patients showed a benign disease.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Computer tomography assisted thoracoscopic surgery (CATS) enabled successful resection in all cases with minimal morbidity. The histological diagnosis led to a treatment change in 42% of the patients. The hybrid-CATS technique provides good access to deeply located small pulmonary nodules and could be particularly valuable in the emerging setting of lung cancer screening.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0258896","type":"journal-article","created":{"date-parts":[[2021,11,3]],"date-time":"2021-11-03T17:29:30Z","timestamp":1635960570000},"page":"e0258896","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Computer tomography guided thoracoscopic resection of small pulmonary nodules in the hybrid theatre"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2742-9045","authenticated-orcid":true,"given":"Ioannis","family":"Karampinis","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2795-5611","authenticated-orcid":true,"given":"Nils","family":"Rathmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Kostrzewa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steffen J.","family":"Diehl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan O.","family":"Schoenberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Hohenberger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric D.","family":"Roessner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,11,3]]},"reference":[{"issue":"1","key":"pone.0258896.ref001","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1148\/radiol.10091808","article-title":"The National Lung Screening Trial: overview and study design","volume":"258","author":"DR Aberle","year":"2011","journal-title":"Radiology"},{"issue":"Supplement_4","key":"pone.0258896.ref002","doi-asserted-by":"crossref","first-page":"iv263","DOI":"10.1093\/annonc\/mdy161","article-title":"Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"29","author":"R Glynne-Jones","year":"2018","journal-title":"Annals of oncology: official journal of the European Society for Medical Oncology \/ ESMO"},{"issue":"1","key":"pone.0258896.ref003","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1093\/ejcts\/ezy301","article-title":"Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS(R)) Society and the European Society of Thoracic Surgeons (ESTS).","volume":"55","author":"TJP Batchelor","year":"2019","journal-title":"European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery"},{"issue":"1","key":"pone.0258896.ref004","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1148\/radiol.2017161659","article-title":"Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017","volume":"284","author":"H MacMahon","year":"2017","journal-title":"Radiology"},{"issue":"8","key":"pone.0258896.ref005","first-page":"1386","article-title":"ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. 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