Placement of 125I implants with the da Vinci robotic system after video-assisted thoracoscopic wedge resection: A feasibility study
Presented in part at the 10th World Conference on Lung Cancer, Vancouver, Canada, August 10–14, 2003.
Received 3 March 2004; received in revised form 8 June 2004; accepted 6 July 2004.
Purpose
To evaluate the feasibility of using the da Vinci robotic system for radioactive seed placement in the wedge resection margin of pigs' lungs.
Methods and materials
Video-assisted thoracoscopic wedge resection was performed in the upper and lower lobes in pigs. Dummy 125I seeds embedded in absorbable sutures were sewn into the resection margin with the aid of the da Vinci robotic system without complications. In the “loop technique,” the seeds were placed in a cylindrical pattern; in the “longitudinal,” they were above and lateral to the resection margin. Orthogonal radiographs were taken in the operating room. For dose calculation, Variseed 66.7 (Build 11312) software was used.
Results
With looping seed placement, in the coronal view, the dose at 1 cm from the source was 97.0 Gy; in the lateral view it was 107.3 Gy. For longitudinal seed placement, the numbers were 89.5 Gy and 70.0 Gy, respectively.
Conclusion
Robotic technology allows direct placement of radioactive seeds into the resection margin by endoscopic surgery. It overcomes the technical difficulties of manipulating in the narrow chest cavity. With the advent of robotic technology, new options in the treatment of lung cancer, as well as other malignant tumors, will become available.
*Department of Radiation Oncology and Physics, Beth Israel and St. Luke's-Roosevelt Medical Center, New York, NY, USA
†Department of Thoracic Surgery, Beth Israel and St. Luke's-Roosevelt Medical Center, New York, NY, USA
Reprint request to: Julianna Pisch, M .D., Beth Israel Medical Center, Department of Radiation Oncology, 1st Avenue and 16th Street, New York, NY 10003. Tel: (212) 420-2592; Fax: (212) 420-3314
Supported by the Lung Cancer Research Fund of Beth Israel Medical Center, New York, NY.
The authors involved in the preparation of this manuscript state that there is no apparent or real conflict of interest with the company supplying the dummy seeds, nor is there any with Ethicon.
ABSTRACT