Fluoroscopy-aided thoracoscopic resection of pulmonary nodule localized with contrast media.
BACKGROUND
The pulmonary nodules have become the major indication of video-assisted thoracic surgery (VATS). Recently, several preoperative or intraoperative techniques for identifying small or deeply seated pulmonary nodules have facilitated thoracoscopic resection. We describe the new technique for detecting difficult lesions.


METHODS
Preoperatively, we marked the visceral pleura near the pulmonary nodules with dye, simultaneously injected contrast media (1 water-soluble Optiray [Mallinckrodt Medical Inc, Quebec, Canada], 18 barium sulfate, 11 Lipiodol [Laboratoire Guerbet, Aulnay-sous-Bois, France]) into or around the nodule under computed tomography (CT) guidance. During VATS, we were able to easily and accurately detect and resect all the nodules localized with contrast media, of which the radiopacity was visualized on the portable fluoroscopic monitor.


RESULTS
Between February 1996 and December 1998, we thoracoscopically resected 30 nodules in 28 patients (13 were women; age, 53 +/- 14 years). The resected nodules were 17 +/- 7.6 mm (range; 4 to 32 mm) in size, and 8.9 +/- 8 mm (range, 2 to 34 mm) in depth. The pathologic diagnosis of the nodules was benign in 20 and malignant in 10 (six primary cancers of lung and four metastatic cancers). There were only minor complications related CT localization.


CONCLUSIONS
This new technique can help the surgeons detect and resect the difficult lesions with safety and rapidity by VATS without thoracotomy.
Moon
S W
SW
Department of Thoracic and Cardiovascular Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. swmoon@cmc.cuk.ac.kr
Wang
Y P
YP
Jo
K H
KH
Kwack
M S
MS
Kim
S W
SW
Kwon
O K
OK
Jang
H S
HS
D000328:Adult; D000368:Aged; D003287:Contrast Media; D003937:Diagnosis, Differential; D004724:Endoscopy; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013906:Thoracoscopy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D003287:Contrast Media