Preoperative marking for peripheral pulmonary nodules in thoracoscopic surgery: a new method without piercing the pulmonary parenchyma

Abstract

Air embolism is a rare complication of computed tomography (CT)-guided preoperative marking of peripheral pulmonary nodules. Here, we describe a new CT-guided marking method, which allows the quick intraoperative identification of peripheral pulmonary nodules and avoids this complication. This method does not require piercing of the pulmonary parenchyma and uses an 18-gauge indwelling catheter and a central venous catheter with a guidewire. Between July 2009 and January 2013, 16 patients underwent this procedure and could be intraoperatively diagnosed without any air embolisms. No postoperative complications were observed in this series. We believe that this simple technique is effective and will not cause severe complications.

Noninvasive computed tomography-guided marking technique for peripheral pulmonary nodules

“…Preoperative marking allows quick intraoperative identification. There are two preoperative marking techniques, CT-guided and bronchoscope-guided (3,8). In CT-guided marking technique, percutaneous hookwire placement is the most common procedure (4,5).…”

“…A CT-guided marking technique that does not puncture the VP is less prone to these complications. We developed and performed a marking technique using CT guidance that does not involve VP puncture, based on the report of Nishida et al (8).…”

A safe method for marking small pulmonary nodules with crystal violet

“…It is necessary to select the thoracic port position by taking into consideration the marking point. New CT-guided marking method [18] No pneumothorax or air embolism Proficiency of technique, anatomical restriction of the marking position…”

“…The advantages and disadvantages of the various marking methods are listed in Table 2 [10][11][12][13][14][15][16][17][18]. Our method showed lower accuracy for the cases with lesions located at the apex or left lower lobe, but this study included only 22 patients.…”

“…For example, the scapula becomes an obstacle, and it is impossible to approach the mediastinal side of the visceral pleura. Several new marking techniques have also been reported, but these were also associated with certain disadvantages [10][11][12][13][14][15][16][17][18].…”