title: An original device for intraoperative detection of small indeterminate nodules†.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the efficiency of our newly designed tactile mechanoreceptor in detection of pulmonary lesions during thoracoscopy.
  
  
  METHODS
  Twenty-seven patients with peripheral undetermined subpleural solitary pulmonary lesions detected on computed tomography were included in a prospective non-randomized trial. All nodules from 7 to 18 mm in diameter were located deep in the lung parenchyma (≥ 10 mm from the lung surface). All patients underwent thoracoscopic exploration with diagnostic intent. Instrumental palpation with lung forceps was performed first, followed by thorough inspection of lung tissue with the tactile mechanoreceptor. This device is a metal tube 10 mm in diameter, which can be inserted into the pleural cavity via a standard 10-mm port. There is an elastic membrane on its working end, which deforms greatly if the palpated tissue has greater density. Intraoperatively, the surgeon pushed the targeted region of pulmonary tissue with the mechanoreceptor and carried out the measurement. The density of tissue characteristics was displayed with special software using colour change in real time. After detection of a pulmonary nodule, it was resected with endostaplers.
  
  
  RESULTS
  Instrumental palpation was successful in detection of pulmonary lesions in 10 (37%) patients and was confirmed with the tactile mechanoreceptor. In 12 (44%) patients, instrumental palpation failed to locate an intrapulmonary nodule, while the tactile mechanoreceptor facilitated finding the lesion and performing thoracoscopic lung resection in all these patients. Intraoperative histological examination confirmed benign disease in 8, metastatic lesion in 12 and primary lung cancer in 7 patients requiring thoracoscopic lobectomy. In 5 (19%) patients, neither forceps nor the tactile mechanoreceptor was able to detect any pulmonary lesion, necessitating mini-thoracotomy for finger palpation. The overall efficacy of the tactile mechanoreceptor in detection of pulmonary lesions was 81%, and of impalpable nodes 71%.
  
  
  CONCLUSIONS
  The tactile mechanoreceptor is an effective tool for detection of impalpable pulmonary lesions during thoracoscopy.
authors.affiliation: Department of Thoracic Surgery, P.A. Herzen Moscow Oncology Research Institute, Moscow, Russian Federation Lomonosov Moscow State University, Moscow, Russian Federation vitaly.barmin@gmail.com.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Barmin
authors.affiliation: Lomonosov Moscow State University, Moscow, Russian Federation.
authors.forename: Victor
authors.initials: V
authors.lastname: Sadovnichy
authors.affiliation: Lomonosov Moscow State University, Moscow, Russian Federation.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Sokolov
authors.affiliation: Department of Thoracic Surgery, P.A. Herzen Moscow Oncology Research Institute, Moscow, Russian Federation.
authors.forename: Oleg
authors.initials: O
authors.lastname: Pikin
authors.affiliation: Department of Thoracic Surgery, P.A. Herzen Moscow Oncology Research Institute, Moscow, Russian Federation.
authors.forename: Ali
authors.initials: A
authors.lastname: Amiraliev
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D055595:Mechanical Phenomena; D008875:Middle Aged; D011446:Prospective Studies; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis* / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000295:instrumentation* / Q000379:methods*
keywords: Mechanoreceptor tactile diagnostics; Solitary pulmonary nodule; Video-assisted thoracoscopic surgery