A Simple and Safe Technique for CT Guided Lung Nodule Marking prior to Video Assisted Thoracoscopic Surgical Resection Revisited

Abstract

Aim. We describe our experience of a simple, safe, and reproducible technique for lung nodule marking prethoracoscopic metastasectomy. Thoracoscopic lung nodule resection reduces patient discomfort, complications, higher level of care, hospital stay, and cost; however, small deeply placed lung nodules are difficult to locate and resect thoracoscopically. Materials and Methods. We describe and review the success of our novel technique, where nodules are identified on a low dose CT and marked with methylene blue using CT fluoroscopy guidance immediately prior to surgery. Results. 30 nodules were marked with a mean size of 8 mm (4–18 mm) located at a mean depth of 17 mm, distributed through both lungs. Dye was detected at the pleural surface in 97% of the patients and at the nodule in 93%. There were no major complications. Thoracoscopic resection was possible in 90%. Conclusion. This is a simple and safe method of lung nodule marking to facilitate thoracoscopic resection in cases where this may not be technically possible due to nodule location.

Computed tomography-guided preoperative localization of small lung nodules with indocyanine green

“…Several techniques have been developed to aid in the identification of pulmonary nodules, including digital palpation (11), the preoperative hookwire technique (4,5,12,13), preoperative microcoil placement (14,15), preoperative dye localization (16)(17)(18)(19)(20)(21)(22)(23)(24), fluoroscopy with contrast medium (25), intraoperative ultrasonography (26), preoperative agar marking (27), the endofinger device for tactile localization (28), radio-guidance (29), or a combination of these methods. Recently, preoperative bronchoscopic lung marking guided by virtual bronchoscopy (virtual-assisted lung mapping) has also been developed (30).…”

Application of the indocyanine green fluorescence imaging method in laparoscopic resection of a solitary retroperitoneal metastasis of renal cell carcinoma: A case report

“…The indication for marking was peripheral pulmonary nodules 20 mm or less in diameter. The nodules were marked with various methods including hookwire, lipiodol and dye marking 10 . On the other hand, marking is rarely used in urological surgery.…”

Planting Seeds into the Lung: Image-Guided Percutaneous Localization to Guide Minimally Invasive Thoracic Surgery

“…For dye localization, the rates of successful targeting during the localization procedure and successful localization in the operative field were 100% and 93.3-100%, respectively (Table 2) (51,52). In a study of 30 small metastatic nodules marked with methylene blue, Stephenson et al (51) reported that 93.3% of the marked nodules could be detected in the operative field and thoracoscopic resection was possible in 90% of the nodules. The major disadvantage of dye localization is rapid diffusion of dye into the surrounding lung parenchyma.…”