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Ann Thorac Surg 1995;60:614
© 1995 The Society of Thoracic Surgeons
DR HANI SHENNIB (Montreal, Quebec, Canada): I guess we are all awaiting the magic stick that would tell us where the nodule is. As I listened to your presentation, you started it with the notion that conventional ultrasonography relies primarily on a well-collapsed lung, and yet if I understand your work, you are still using ultrasonography technology and you still require that the lung be collapsed. I am not trying to knock down all of this, I think it is exciting, but what we need is an instrument for which you do not really need to find out where the nodule is before you use it, something where you could screen the lung with and pick up the nodules. Therefore I recognize that this is a very limited and preliminary technology, but three things come to mind: First of all, does the lung remain expanded or do you need to have it collapsed? Second, do you need to identify the nodule before you identify it? Finally, the nodule that you showed in your presentation is reasonably large, so I wonder, did you really need the localization technique to pick it up?
DR KOHNO: First, we did this procedure to find the nodule, but as I showed in Table 2, complete collapse is not necessary for this technique; therefore this is the advantage over ultrasonography. It is true that we have to know the existence of the tumors before the operation to find these nodules. We cannot look for a small nodule in a large area with this technique; that is true. And as for the last question, we have to find out smaller and smaller nodules in thoracoscopic operations in Japan, and probably in this country as well. Helical computed tomographic scan is going to be used as our screening test for lung cancer. So smaller and smaller nodules will be identified, but without thoracoscopic operations that nodule cannot be diagnosed. We have to handle smaller and smaller nodules from now on, so we need this kind of technique. That is the answer.
DR TODD L. DEMMY (Columbia, MO): I think you may have already touched on one of my questions, that is, is this technique able to give you a depth for the nodule so you can better plan your wedge excision? Have you discovered any nodules that you were not expecting to find based on the preoperative computed tomogram? I ask because of concerns that using thoracoscopy may lead to missed metastatic or other nodules that are palpable but not detected by computed tomographic imaging.
DR KOHNO: In our experience we found only one unsuspected nodule that was not found on the preoperative computed tomographic scan. So it can happen that we resect something that was not preoperatively found. But we have to be careful on the location of the nodule by using a preoperative computed tomographic scan.
DR STEVEN J. MENTZER (Boston, MA): Doctor Kohno, how does your sensor compare to more old-fashioned devices, like your finger? How many of those nodules were not detected by your finger but were detected by the sensor?
DR KOHNO: This sensor is made by a robot technology; therefore, this sensor is very much like the sense of our finger. This sensor is made to resemble our finger.
DR MENTZER: So you are using it in situations where you cannot use your finger; is that correct?
DR KOHNO: That is correct.
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