Comparison of bronchial methylene blue staining and modified inflation-deflation method in identifying the intersegmental plane during lung segmentectomy

Abstract

Background: Identification of the intersegmental plane (ISP) is the critical step in lung segmentectomy because of the complicated anatomic variations. Bronchial methylene blue staining was developed by our team in 2015 and is now commonly used at our center, it could rapidly and accurately identify the ISP. In this study, we aimed to compare bronchial methylene blue staining with the modified inflation-deflation method in terms of their perioperative characteristics and to present our experience of the methylene blue method.Methods: From June 2020 to September 2021, the data of 112 patients with pulmonary ground-glass nodules who underwent segmentectomy by video-assisted thoracoscopic surgery were retrospectively reviewed. Sixty-two patients underwent bronchial methylene blue staining, and 50 patients underwent the modified inflation-deflation method.Results: Both methods could accurately identify the ISP. The time taken to clearly display the ISP (82.94±28.08 vs. 868.20±145.89 seconds; P<0.001) and the surgical duration (131.69±32.05 vs.146.08±28.11 minutes; P=0.014) were significantly shorter in the bronchial methylene blue staining group than in the modified inflation-deflation group. There were no significant differences between the two groups in the bleeding volume, drainage time, and length of postoperative hospital stay, as well as in most other perioperative characteristics.Conclusions: Compared with the modified inflation-deflation method, the bronchial methylene blue staining method can quickly display the ISP and shorten the surgical duration. This method is safe and feasible, can be widely applied during thoracoscopic anatomic segmentectomy.

The role of bronchoscopy as a novel approach in preoperative lung marking for early-stage lung cancer

“…Wang and colleagues explored an exciting approach to integrate these goals with the use of methylene blue dye marking to shorten operative time as compared to inflation-deflation technique (1). Similarly, our group would like to highlight the opportunity to employ navigational bronchoscopy to achieve similar goals.…”

“…We read the recently published article, "Comparison of bronchial methylene blue staining and modified inflationdeflation method in identifying the intersegmental plane during lung segmentectomy," by Wang and colleagues with great interest (1). We congratulate the authors on this successful submission on an emerging topic and appreciate the opportunity to offer a few comments.…”

Precise identification of the intersegmental plane for lung cancer segmentectomy

“…In a recent study, Wang and colleagues have reported regarding this issue. They compared between the bronchial methylene blue staining method as a transbronchial method and the modified inflation-deflation method as a transvascular method (13). They retrospectively reviewed 62 patients underwent bronchial methylene blue staining, and 50 patients underwent the modified inflation-deflation method.…”