Electromagnetic Navigation Bronchoscopy-Guided Thoracoscopic Wedge Resection of Small Pulmonary Nodules

Abstract

Video assisted thoracoscopic (VATS) wedge resection of a small non-palpable and non-visible pulmonary nodule (PN) is a commonly encountered clinical challenge. A variety of techniques have been described to mark the pleural surface in the vicinity of a small PN and guide thoracoscopic resection: computerized tomography-guided percutaneous placement of wires, coils, or radio-opaque dye; intraoperative ultrasonography; and electromagnetic navigation bronchoscopy (ENB)-guided dye injection ( 1 Hänninen E.L. Langrehr J. Raakow R.R. et al. Computed tomography-guided pulmonary nodule localization before thoracoscopic resection. Acta Radiol. 2004; 45: 284-288 Crossref PubMed Scopus (16) Google Scholar , 2 Kang D. Kim H.K. Kim Y.K. et al. Needlescopy-assisted resection of pulmonary nodule after dual localization. Eur Respir J. 2010; (Epub ahead of print) Google Scholar , 3 Mayo J.R. Clifton J.C. Powell T.I. et al. Lung nodules: CT-guided placement of microcoils to direct video-assisted thoracoscopic surgical resection. Radiology. 2009; 250: 576-585 Crossref PubMed Scopus (145) Google Scholar , 4 Kawanaka K. Nomori H. Mori T. et al. Marking of small pulmonary nodules before thoracoscopic resection: Injection of lipiodol under CT-fluoroscopic guidance. Acta Radiol. 2009; 16: 39-45 Scopus (42) Google Scholar , 5 Grogan E.L. Jones D.R. Kozower B.D. et al. Identification of small lung nodules: Technique of radiotracer-guided thoracoscopic biopsy. Ann Thorac Surg. 2008; 85: S772-S777 Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar , 6 Santambrogio R. Montorsi M. Bianchi P. et al. Intraoperative ultrasound during thoracoscopic procedures for solitary pulmonary nodules. Ann Thorac Surg. 1999; 68: 218-222 Abstract Full Text Full Text PDF PubMed Scopus (115) Google Scholar ). However, each of these techniques has practical limitations. We propose a technique that may circumvent the logistical problems of previously described approaches.