Methylene blue-stained autologous blood for needle localization and thoracoscopic resection of deep pulmonary nodules.
OBJECTIVE
Video-assisted thoracoscopic surgery (VATS) has used a variety of preoperative techniques to localize deep pulmonary nodules including wires, plain methylene blue, colored collagen, indigo carmine, India ink, and barium. The authors describe their experience with a computed tomography (CT)-guided localization technique using autologous blood stained with methylene blue.


METHODS
The authors reviewed retrospectively children who had pulmonary nodules localized using CT guidance with a mixture containing 3 mL autologous blood stained with 0.3 mL methylene blue. Nodules were resected by standard VATS technique. Postoperative chest tube drainage was performed selectively.


RESULTS
Nineteen procedures were performed in 17 children (average age, 11 years). Operating time (range, 21 to 171 minutes) varied depending on the number of nodules resected. All resections were diagnostic, and 80% represented malignancy. Lesions averaged 0.9 cm in size (range, 0.3 to 3 cm) with an average pulmonary depth of 0.8 cm (range, 0.1 cm to 1.8 cm). One patient required conversion to an open thoracotomy because of malfunction of the endoscopic stapler. Forty percent of the children received chest tubes, and 53% were discharged home the same day.


CONCLUSIONS
VATS diagnostic resection of deep pulmonary nodules preoperatively localized with methylene blue stained autologous blood is safe and effective.
McConnell
Patrick I
PI
Division of Pediatric Surgery, Primary Children's Medical Center, Salt Lake City, UT 84113-1100, USA.
Feola
G Peter
GP
Meyers
Rebecka L
RL
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008175:Lung Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery; D008751:Methylene Blue / Q000032:analysis*; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000097:blood / Q000000981:diagnostic imaging* / Q000601:surgery*; D013906:Thoracoscopy / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
D008751:Methylene Blue