Use of India Ink During Preoperative Computed Tomography Localization of Small Peripheral Undiagnosed Pulmonary Nodules for Thoracoscopic Resection

Magistrelli, Prospero; D’Ambra, Luigi; Berti, Stefano; Feleppa, Cosimo; Stefanini, Teseo; Falcò, Emilio

doi:10.1007/s00268-009-0068-5

Cited by 29 publications

(21 citation statements)

References 12 publications

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“…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). Similar to the microcoil technique described above, most series involve the percutaneous placement of the contrast material yet some recent reports are using bronchoscopic guidance for pleural dye marking (53,54).…”

Section: Discussionmentioning

confidence: 99%

“…This technique has also been used in children, with one series reporting lung tattooing and VATS resection during the same general anaesthetic (55,56). The main cited limitation of this technique is that of diffusion of the contrast material and inability to accurately localize the pulmonary nodules, although in the studies mentioned above the technique was very successful with minimal complications (48,50). The use of surgical navigation systems with placement of skin fiducials to guide methylene blue injection has also been reported (57).…”

Section: Discussionmentioning

confidence: 99%

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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%

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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“…However, they can be challenging to palpate, especially during thoracoscopic surgery. This challenge has led thoracic surgeons to devise methods of lung marking, such as CT-guided needle-mediated placement of markers, such as hook-wires (13) and dye injections (14,15). However, complications, including pneumothorax (30-50%), dislodgement of hook wires (up to 9%) (2), and potentially fatal air embolisms (1-2%) (16)(17)(18)(19), remain drawbacks.…”

Section: From Marking To Mappingmentioning

confidence: 99%

Techniques of stapler-based navigational thoracoscopic segmentectomy using virtual assisted lung mapping (VAL-MAP)

Sato¹,

Murayama²,

Nakajima³

2016

J. Thorac. Dis.

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Anatomical segmentectomies play an important role in oncological lung resection, particularly for ground-glass types of primary lung cancers. This operation can also be applied to metastatic lung tumors deep in the lung. Virtual assisted lung mapping (VAL-MAP) is a novel technique that allows for bronchoscopic multi-spot dye markings to provide "geometric information" to the lung surface, using three-dimensional virtual images. In addition to wedge resections, VAL-MAP has been found to be useful in thoracoscopic segmentectomies, particularly complex segmentectomies, such as combined subsegmentectomies or extended segmentectomies. There are five steps in VAL-MAP-assisted segmentectomies: (I) "standing" stitches along the resection lines; (II) cleaning hilar anatomy; (III) confirming hilar anatomy; (IV) going 1 cm deeper; (V) step-by-step stapling technique. Depending on the anatomy, segmentectomies can be classified into linear (lingular, S6, S2), V-or U-shaped (right S1, left S3, S2b + S3a), and three dimensional (S7, S8, S9, S10) segmentectomies. Particularly three dimensional segmentectomies are challenging in the complexity of stapling techniques. This review focuses on how VAL-MAP can be utilized in segmentectomy, and how this technique can assist the stapling process in even the most challenging ones.

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“…Furthermore, a bronchioloalveolar carcinoma with a GGO finding on CT frequently cannot be palpated or visualised, even in the case of lesions that are located just beneath the visceral pleura [4][5][6][7][8]. Therefore, pre-operative localisation of these pulmonary lesions is mandatory and various localisation techniques have been described, either pre-operatively (microcoils, dye, hookwire and lipiodol) [8][9][10][11][12] or intrathoracoscopically (finger palpation, intrathoracoscopic ultrasound and radio-guided surgery) [13,14]. However, to our knowledge, none of these methods have been widely adopted because of some negative aspects of the techniques during the operation.…”

mentioning

confidence: 99%

Needlescopy-assisted resection of pulmonary nodule after dual localisation

Dy¹,

Hk²,

Yk³

et al. 2010

Eur Respir J

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The aim of this study was to evaluate the feasibility of dual localisation with hookwire and lipiodol before needlescopy-assisted resection for pulmonary nodule.Computed tomography-guided dual marking was performed on 36 pulmonary nodules of 32 patients and needlescopy-assisted resection was performed monitored by C-arm fluoroscopy.The mean age of the patients was 58¡12 (range 12-77) yrs. The mean size of the nodules was 7.5¡3.7 (3-17) mm. Their mean distance from the pleural surface was 7.3¡7.5 (0-35) mm. There were nine pure ground-glass opacity lesions, five semi-solid lesions and 22 solid lesions. The time of the dual localisation procedure was 13.1¡4.8 (7-23) min. Complications of the marking were pneumothorax in nine patients, and intrapulmonary bleeding in three. One hookwire dislodged during the operation. All nodules were successfully resected under needlescopy without conversion to a conventional thoracoscopy (5 mm or 10 mm thoracoscopy) or a minithoracotomy. There was no complication related to needlescopy-assisted resection.Dual marking with hookwire and lipiodol is a safe and none time consuming procedure, and needlescopy-assisted lung resection for small nodules is technically feasible and useful for histological diagnosis and treatment.

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Use of India Ink During Preoperative Computed Tomography Localization of Small Peripheral Undiagnosed Pulmonary Nodules for Thoracoscopic Resection

Abstract: Our experience suggests that this CT technique, which includes using India ink to label and localize peripheral small pulmonary nodules, is a safe, valid option for marking the lung, thereby facilitating subsequent thoracoscopic resection.

Cited by 29 publications

References 12 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

Techniques of stapler-based navigational thoracoscopic segmentectomy using virtual assisted lung mapping (VAL-MAP)

Needlescopy-assisted resection of pulmonary nodule after dual localisation

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