Abstract
BackgroundQuickly and accurately localizing small peripheral pulmonary lesions can avoid prolonged operative time and unplanned open thoracotomy. In this study, we aimed to introduce and evaluate a new technique combining virtual simulation and methylene blue staining for the localization of small peripheral pulmonary lesions.MethodsSeventy four (74) patients with 80 peripheral pulmonary lesions <20 mm in size on computer tomography (CT) were virtually punctured using a radiotherapy planning simulator on the day before operation. Under general anaesthesia, methylene blue dye was injected to the virtually identified point according to the surface point, angle and depth previously determined by the simulator. The wedge resection of the marked lesion was performed under video-assisted thoracoscopic surgery (VATS) and the specimens were sent for immediate pathologic examination. According to pathology results, appropriate surgical procedures were decided and undertaken.ResultsThe average lesion size was 10.4±3.5 mm (range: 4-17 mm) and the average distance to the pleural surface was 9.4±4.9 mm. Our preoperative localization procedure was successful in 75 of 80 (94%) lesions. Histological examination showed 28 benign lesions and 52 lung cancers. The shortest distance between the edges of the stain and lesion was 5.1±3.1 mm. Localization time was 17.4±2.3 min. All patients with malignant lesions subsequently underwent lobectomy and systematic lymph node dissection. No complications were observed in all participants.ConclusionsThe novel technique combining the preoperative virtual simulation and methylene blue staining techniques has a high success rate for localizing small peripheral pulmonary lesions, particularly for those tiny lesions which are difficult to visualise and palpate during VATS.
Highlights
And accurately localizing small peripheral pulmonary lesions can avoid prolonged operative time and unplanned open thoracotomy
We introduce a novel technique which applies the virtual simulation, a technique for radiotherapy planning [10,11], in combination with methylene blue staining for the localization of small peripheral pulmonary nodules
Participants with at least one of the following were excluded: 1) lesions >20 mm which could be localized, 2) lesions located in the middle and inner two thirds of the lung field where the wedge resection was not feasible, 3) lesions close to the pleural surface with visible pleural retraction, 4) impossible to inject methylene blue dye because the identified lesions were blocked by a large skeletal structure such as scapula according to computer tomography (CT) scanning results, and 5) lesions close to heart, large blood vessels, diaphragm and major nerves with a high risk of injuring them
Summary
And accurately localizing small peripheral pulmonary lesions can avoid prolonged operative time and unplanned open thoracotomy. We aimed to introduce and evaluate a new technique combining virtual simulation and methylene blue staining for the localization of small peripheral pulmonary lesions. The widespread utilization of CT scanning and the increasing awareness of health screening have resulted in identification of a large number of small pulmonary lesions. The wedge resection of the nodule is performed first for pathologic examination, and further treatment planning in combination with methylene blue staining for the localization of small peripheral pulmonary nodules. We describe this procedure and assess the performance of this technique in 80 small peripheral pulmonary lesions from 74 Chinese patients
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