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Ann Thorac Surg 1999;68:1815-1820
© 1999 The Society of Thoracic Surgeons

Original Articles

Fluoroscopy-aided thoracoscopic resection of pulmonary nodule localized with contrast media

Seok-Whan Moon, MDa, Young-Pil Wang, MDa, Keon-Hyon Jo, MDa, Moon-Sub Kwack, MDa, Se-Wha Kim, MDa, Ou-Kyoung Kwon, MDa, Hye-Suk Jang, MDa

a Departments of Thoracic and Cardiovascular Surgery, Anesthesiology, and Radiology, College of Medicine, The Catholic University of Korea, Seoul, South Korea

Address reprint requests to Dr Moon, Department of Thoracic and Cardiovascular Surgery, Kang Nam St Mary Hospital, 505 Banpo-Dong, Socho-Ku, Seoul 137-040, Republic of Korea
e-mail: swmoon{at}cmc.cuk.ac.kr

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.




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