Pleural dye marking using radial endobronchial ultrasound combined with virtual bronchoscopy before minimal invasive sublobar lung resection

Abstract

Introduction: Surgical resection of pulmonary nodules with minimally invasive techniques is challenging as the procedures have decreased the ability to palpate the lung in comparison with open thoracotomy. The objective of this study was to evaluate the feasibility of pleural dye marking using radial-EBUS (r-EBUS) combined with virtual bronchoscopy (VB) to help minimally invasive resection of small peripheral lung nodule (SPLN) or ground glass opacities (GGOs). Methods: Both bronchial path to nodule (LungPoint Software®) and sub-pleural methylene blue deposition were performed in the operating room immediately before minimally invasive surgery. A 4 mm fiberscope with a 2mm working channel, 1.4 mm r-EBUS probe and guide sheath were used under general anesthesia without fluoroscopy guidance, in a patient on operating position. One ml of methylene blue was inserted into the guide sheath at the end of the procedure. RESULTS: 15 sublobar nodule resections were performed in 13 patients including 4 GGOs. Median nodule’s greatest diameter was 8 mm (4 to 15 mm, 14 nodules Conclusion: r-EBUS combined with VB allows dye localization of SPLN before minimally invasive resection.