Video-Assisted Thoracoscopic Surgery After Preoperative CT-Guided Lipiodol Marking of Small or Impalpable Pulmonary Nodules

Overview

Journal Ann Thorac Cardiovasc Surg

Specialties Cardiology & Vascular Diseases
General Surgery
Pulmonary Medicine

Date 2015 May 26

PMID 26004116

Citations 18

Authors

Akira Mogi

Toshiki Yajima

Kenji Tomizawa

Ryoichi Onozato

Shigebumi Tanaka

Hiroyuki Kuwano

Affiliations

Soon will be listed here.

Abstract

Purpose: Small pulmonary lesions that include ground-glass attenuation have been increasingly discovered because of progressive imaging diagnostic technologies. Despite the detection of such small lesions, sometimes it is quite difficult to localize them because of their size or considerable depth from the visceral pleura. In the present study, we examined the usefulness of computed tomography-guided lipiodol marking for thoracoscopic resection of impalpable pulmonary nodules.

Methods: Fifty-six patients with an undiagnosed peripheral lesion(s) of the lung who had undergone preoperative computed tomography-guided lipiodol marking followed by video-assisted thoracoscopic surgery were studied.

Results: All of the nodules were successfully marked by computed tomography-guided lipiodol marking, and all except for one case were localized by means of intraoperative fluoroscopy as clear spots. With regard to complications, pneumothorax occurred in 21 patients (37.5%), and only one patient required transient drainage. Although hemorrhaging in the lung parenchyma and hemosputum occurred in nine patients (16.1%) and one patient (1.8%), respectively, no patients were in serious condition. No intra- or postoperative mortality or morbidity was observed.

Conclusion: Preoperative computed tomography-guided lipiodol marking of small or impalpable pulmonary nodules is a safe and useful procedure for thoracoscopic resection of the lung.

Citing Articles

Uniportal video-assisted thoracic surgery resection of subsolid or millimetric nodules using an innovative micro-coil technique: our experience.

Congedo M, Contegiacomo A, Nachira D, Chiappetta M, Calabrese G, Lippi M J Thorac Dis. 2025; 16(12):8424-8434.

PMID: 39831241 PMC: 11740051. DOI: 10.21037/jtd-24-628.

Intraoperative Transbronchial Metallic Coil Marking for Small Peripheral Pulmonary Lesions in a Hybrid Operation Room.

Kawakita N, Toba H, Miyamoto N, Sakamoto S, Sumitomo H, Takeuchi T Cancers (Basel). 2024; 16(23).

PMID: 39682224 PMC: 11640022. DOI: 10.3390/cancers16234038.

Ultrasound for Intra-Operative Detection of Peri-Centimetric Pulmonary Nodules in Uniportal Video-Assisted Thoracic Surgery (VATS): A Comparison with Conventional Techniques in Multiportal VATS.

Bastone S, Patirelis A, Luppichini M, Ambrogi V J Clin Med. 2024; 13(15).

PMID: 39124715 PMC: 11313293. DOI: 10.3390/jcm13154448.

Uniportal Video-Assisted Thoracoscopic Segmentectomy for Early-Stage Non-Small Cell Lung Cancer: Overview, Indications, and Techniques.

Watanabe T, Tanahashi M, Suzuki E, Yoshii N, Kohama T, Iguchi K Cancers (Basel). 2024; 16(13).

PMID: 39001405 PMC: 11240445. DOI: 10.3390/cancers16132343.

Intraoperative identification of pulmonary nodules during minimally invasive thoracic surgery: a narrative review.

Tang L, Zhang Y, Wang Y Quant Imaging Med Surg. 2022; 12(11):5271-5287.

PMID: 36330174 PMC: 9622445. DOI: 10.21037/qims-22-309.

References

Dendo S, Kanazawa S, Ando A, Hyodo T, Kouno Y, Yasui K . Preoperative localization of small pulmonary lesions with a short hook wire and suture system: experience with 168 procedures. Radiology. 2002; 225(2):511-8. DOI: 10.1148/radiol.2252011025. View

Mayo J, Clifton J, Powell T, English J, Evans K, Yee J . Lung nodules: CT-guided placement of microcoils to direct video-assisted thoracoscopic surgical resection. Radiology. 2009; 250(2):576-85. DOI: 10.1148/radiol.2502080442. View

Ikeda K, Nomori H, Mori T, Kobayashi H, Iwatani K, Yoshimoto K . Impalpable pulmonary nodules with ground-glass opacity: Success for making pathologic sections with preoperative marking by lipiodol. Chest. 2007; 131(2):502-6. DOI: 10.1378/chest.06-1882. View

Kawanaka K, Nomori H, Mori T, Ikeda K, Ikeda O, Tomiguchi S . Marking of small pulmonary nodules before thoracoscopic resection: injection of lipiodol under CT-fluoroscopic guidance. Acad Radiol. 2008; 16(1):39-45. DOI: 10.1016/j.acra.2008.07.012. View

Toba H, Kondo K, Miyoshi T, Kajiura K, Yoshida M, Kawakami Y . Fluoroscopy-assisted thoracoscopic resection after computed tomography-guided bronchoscopic metallic coil marking for small peripheral pulmonary lesions. Eur J Cardiothorac Surg. 2013; 44(2):e126-32. DOI: 10.1093/ejcts/ezt220. View

Tomiyama N, Yasuhara Y, Nakajima Y, Adachi S, Arai Y, Kusumoto M . CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol. 2006; 59(1):60-4. DOI: 10.1016/j.ejrad.2006.02.001. View

Wicky S, Dusmet M, Doenz F, Ris H, Schnyder P, Portier F . Computed tomography-guided localization of small lung nodules before video-assisted resection: experience with an efficient hook-wire system. J Thorac Cardiovasc Surg. 2002; 124(2):401-3. DOI: 10.1067/mtc.2002.124257. View

Horan T, Pinheiro P, Araujo L, Santiago F, Rodrigues M . Massive gas embolism during pulmonary nodule hook wire localization. Ann Thorac Surg. 2002; 73(5):1647-9. DOI: 10.1016/s0003-4975(01)03371-9. View

Moon S, Wang Y, Jo K, Kwack M, Kim S, Kwon O . Fluoroscopy-aided thoracoscopic resection of pulmonary nodule localized with contrast media. Ann Thorac Surg. 1999; 68(5):1815-20. DOI: 10.1016/s0003-4975(99)00764-x. View

10.

Watanabe K, Nomori H, Ohtsuka T, Kaji M, Naruke T, Suemasu K . Usefulness and complications of computed tomography-guided lipiodol marking for fluoroscopy-assisted thoracoscopic resection of small pulmonary nodules: experience with 174 nodules. J Thorac Cardiovasc Surg. 2006; 132(2):320-4. DOI: 10.1016/j.jtcvs.2006.04.012. View

11.

Asano F, Shindoh J, Shigemitsu K, Miya K, Abe T, Horiba M . Ultrathin bronchoscopic barium marking with virtual bronchoscopic navigation for fluoroscopy-assisted thoracoscopic surgery. Chest. 2004; 126(5):1687-93. DOI: 10.1378/chest.126.5.1687. View

12.

Shentu Y, Zhang L, Gu H, Mao F, Cai M, Ding Z . A new technique combining virtual simulation and methylene blue staining for the localization of small peripheral pulmonary lesions. BMC Cancer. 2014; 14:79. PMC: 3926337. DOI: 10.1186/1471-2407-14-79. View

13.

Mack M, Gordon M, Postma T, Berger M, Aronoff R, Acuff T . Percutaneous localization of pulmonary nodules for thoracoscopic lung resection. Ann Thorac Surg. 1992; 53(6):1123-4. DOI: 10.1016/0003-4975(92)90407-u. View

14.

Kerrigan D, Spence P, Crittenden M, Tripp M . Methylene blue guidance for simplified resection of a lung lesion. Ann Thorac Surg. 1992; 53(1):163-4. DOI: 10.1016/0003-4975(92)90783-z. View

15.

Lizza N, Eucher P, Haxhe J, De Wispelaere J, Johnson P, Delaunois L . Thoracoscopic resection of pulmonary nodules after computed tomographic-guided coil labeling. Ann Thorac Surg. 2001; 71(3):986-8. DOI: 10.1016/s0003-4975(00)02505-4. View

16.

Suzuki K, Nagai K, Yoshida J, Ohmatsu H, Takahashi K, Nishimura M . Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodules: indications for preoperative marking. Chest. 1999; 115(2):563-8. DOI: 10.1378/chest.115.2.563. View

17.

Okumura T, Kondo H, Suzuki K, Asamura H, Kobayashi T, Kaneko M . Fluoroscopy-assisted thoracoscopic surgery after computed tomography-guided bronchoscopic barium marking. Ann Thorac Surg. 2001; 71(2):439-42. DOI: 10.1016/s0003-4975(00)02378-x. View

18.

Sakiyama S, Kondo K, Matsuoka H, Yoshida M, Miyoshi T, Yoshida S . Fatal air embolism during computed tomography-guided pulmonary marking with a hook-type marker. J Thorac Cardiovasc Surg. 2003; 126(4):1207-9. DOI: 10.1016/s0022-5223(03)00821-3. View

19.

Miyoshi T, Kondo K, Takizawa H, Kenzaki K, Fujino H, Sakiyama S . Fluoroscopy-assisted thoracoscopic resection of pulmonary nodules after computed tomography--guided bronchoscopic metallic coil marking. J Thorac Cardiovasc Surg. 2006; 131(3):704-10. DOI: 10.1016/j.jtcvs.2005.09.019. View

20.

Endo M, Kotani Y, Satouchi M, Takada Y, Sakamoto T, Tsubota N . CT fluoroscopy-guided bronchoscopic dye marking for resection of small peripheral pulmonary nodules. Chest. 2004; 125(5):1747-52. DOI: 10.1378/chest.125.5.1747. View