Fluoroscopy-aided thoracoscopic resection of pulmonary nodule localized with contrast media

Moon, Seok Whan; Wang, Young-Pil; Jo, Keon-Hyon; Kwack, Moon-Sub; Kim, Sewha; Kwon, Ou-Kyoung; Jang, Hye-Suk

doi:10.1016/s0003-4975(99)00764-x

Cited by 88 publications

(64 citation statements)

References 9 publications

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“…Some studies report the injection of a combination of both contrast material and a pigmented material, such as indigo carmine or methylene blue, with successful resection of all nodules (46). In one series, there was a delay up to one day after contrast injection until VATS resection, although this time lag did not affect the success of the procedure (47). The sole use of methylene blue, India ink, lipiodol and barium have also be reported in a few small series (48)(49)(50)(51)(52).…”

Section: Discussionmentioning

confidence: 99%

CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature

et al. 2016

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Background: Video-assisted thoracoscopic surgery (VATS) is standard of care for small lung resections at many centres. Computed tomography (CT)-guided insertion of microcoils can aid surgeons in performing VATS resections for non-palpable lung nodules deep to the lung surface.Methods: Retrospective analysis of CT-guided microcoil insertions prior to VATS lung resection at a single institution from October 2008 to January 2014.Results: A total of 63 patients were included (37% male, mean age 61.6±11.4 years). Forty-two patients (67%) had a history of smoking, with 10 current smokers. Sixty one (97%) patients underwent wedge resection and 3 (5%) patients had segmentectomy. Three (5%) patients required intra-operative staple line re-resection for positive or close margins. Eleven (17%) patients had a completion lobectomy, 5 of which were during the same anaesthetic. The average time between the CT-guided insertion and start of operation was 136.6±89.0 min, and average operative time was 84.0±53.3 min. The intra-operative complication rate was 5% (n=3), including 1 episode of hemoptysis, and 2 conversions to thoracotomy. The post-operative complication rate was 8% (5 patients), and included 2 air leaks, 1 hemothorax (drop in hemoglobin), 1 post chest tube removal pneumothorax, and one venous infarction of the lingula after lingula-sparing lobectomy requiring completion lobectomy. . Average post-operative length of stay was 2.2 days. A diagnosis was made for all patients.Conclusions: CT-guided microcoil insertion followed by VATS lobectomy is safe, with short operative times, short length of stay and 100% diagnosis of small pulmonary nodules. This technique will become more important in the future with increasing numbers of small nodules detected on CT as part of lung cancer screening programs.

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Section: Discussionmentioning

confidence: 99%

CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature

et al. 2016

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“…of VATS pulmonary resection, and our rate of 98.3% was comparable to that in previous reports. [2][3][4][5] Preoperative lipiodol marking of impalpable pulmonary nodules has several advantages over other marking methods such as metallic coil, [6][7][8][9] hook wire, [10][11][12][13][14] dye, [15][16][17] and barium. [18][19][20] First, it is possible to determine the proper central surgical cut lines because lipiodol can be injected adjacent to targeted lesions.…”

Section: Discussionmentioning

confidence: 99%

“…2) Although we did not encounter any instances of systemic embolism during the marking procedure, lipiodol poses a potential risk of systemic embolism, as the compound is insoluble in water. The marking procedure using lipiodol was first reported by Moon et al in 1999, and despite the relative large amount of lipiodol (1 ml), there were only minor complication in 28 patients. 4) In the present study, only 0.2 mL to 0.6 mL (mean 0.34 mL ± 0.13 mL) of lipiodol was used and was sufficient for marking; this amount is relatively smaller than that used in previous reports.…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative localization appears to resolve the former issue, and a number of small nodule localization techniques aimed at guiding VATS resection have been developed. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Although there are many techniques for preoperative localization of pulmonary lesions, CT-guided lipiodol marking may be the most appropriate method for impalpable pulmonary lesions for several reasons. We describe the procedure and assess the usefulness of the CT-guided lipiodol marking technique based on our experiences.…”

Section: Introductionmentioning

confidence: 99%

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Video-Assisted Thoracoscopic Surgery after Preoperative CT-Guided Lipiodol Marking of Small or Impalpable Pulmonary Nodules

Mogi

Yajima

Tomizawa

et al. 2015

ATCS

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Purpose: Small pulmonary lesions that include ground-glass attenuation have been increasingly discovered because of progressive imaging diagnostic technologies. Despite the detection of such small lesions, sometimes it is quite difficult to localize them because of their size or considerable depth from the visceral pleura. In the present study, we examined the usefulness of computed tomography-guided lipiodol marking for thoracoscopic resection of impalpable pulmonary nodules. Methods: Fifty-six patients with an undiagnosed peripheral lesion(s) of the lung who had undergone preoperative computed tomography-guided lipiodol marking followed by video-assisted thoracoscopic surgery were studied. Results: All of the nodules were successfully marked by computed tomography-guided lipiodol marking, and all except for one case were localized by means of intraoperative fluoroscopy as clear spots. With regard to complications, pneumothorax occurred in 21 patients (37.5%), and only one patient required transient drainage. Although hemorrhaging in the lung parenchyma and hemosputum occurred in nine patients (16.1%) and one patient (1.8%), respectively, no patients were in serious condition. No intra-or postoperative mortality or morbidity was observed. Conclusion: Preoperative computed tomography-guided lipiodol marking of small or impalpable pulmonary nodules is a safe and useful procedure for thoracoscopic resection of the lung.

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“…Non-palpable, non-visible GGOs will further exacerbate the difficulties faced in readily finding these lesions for resection. Moon, et al has proposed injecting such lesions with contrast media under CT scan guidance then using fluoroscopy in the operating room to help localize and resect these areas (7,8). Although preliminary results are encouraging, the operative component may be cumbersome.…”

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confidence: 99%

Agar blue localization of small pulmonary nodules and ground glass opacifications for thoracoscopic resection

Klijian¹

2016

J. Thorac. Dis.

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Background: Screening for lung cancer using high resolution computed tomography (CT) has produced encouraging early results. Extremely small nodules and non-palpable areas of opacifications are able to be detected, but pose a challenge to the thoracic surgeon trying to resect these areas.Methods: Forty five patients with ground glass opacifications (GGOs) or small pulmonary nodules underwent pre-operative CT-guided placement of methylene blue dyed agar and/or hook wire needle localization prior to thoracoscopic resection. Progel was applied to any intraoperative air leaks observed after successful resection.Results: All lesions were successfully excised thoracoscopically. The blue agar aided in localization of these areas and did not affect the histological architecture during pathologic evaluation.Conclusions: Careful pre-operative evaluation and planning, including use of selective CT-guided blue agar localization and hook wire placement, may greatly assist in thoracoscopically locating and resecting these often difficult-to-visualize lesions. resection. Non-palpable, non-visible GGOs will further exacerbate the difficulties faced in readily finding these lesions for resection. Moon, et al. has proposed injecting such lesions with contrast media under CT scan guidance then using fluoroscopy in the operating room to help localize and resect these areas (7,8). Although preliminary results are encouraging, the operative component may be cumbersome. Others have advocated the use of dye (methylene blue or indigo carmine) injected under CT scan guidance into such areas, but experience has shown that often the dye dissipates into surrounding normal lung tissue (9,10). A third alternative is the use of a Kopans hook wire for guidance, and though helpful for peripheral lesions, the efficacy drops significantly for deeper parenchymal lung lesions (11)(12)(13)(14)(15)(16). Intra-operative ultrasonography may also be helpful for peripheral lung nodules, but is not very beneficial for deeper lesions or GGOs (17). Newer techniques have been proposed, such as injection of methyl macrylate in an attempt to harden the area thus rendering the lesion palpable. Concerns over the potential adverse health effects of methyl macrylate as well as the effects on local histologic architecture in these already difficult to pathologically diagnose areas have tempered widespread use of this technique. MethodsOne possible way to make resection of these areas easier is by using an inert, colorful material that could become palpable and yet not destroy the histology. In an attempt to localize several small pulmonary nodules and GGOs, liquid agar was mixed with methylene blue and was subsequently injected under CT scan guidance into the area of concern. The agar hardened, leaving a blue palpable lesion readily apparent thus easily resected. Agar has been used previously as a localizing method in human tissues and the blue dye adds visual help. The agar technique also has the added benefit of not distorting the pathologic architecture of the re...

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Fluoroscopy-aided thoracoscopic resection of pulmonary nodule localized with contrast media

Cited by 88 publications

References 9 publications

CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature

CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature

Video-Assisted Thoracoscopic Surgery after Preoperative CT-Guided Lipiodol Marking of Small or Impalpable Pulmonary Nodules

Agar blue localization of small pulmonary nodules and ground glass opacifications for thoracoscopic resection

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