Preoperative computed tomography-guided dye injection to localize multiple lung nodules for video-assisted thoracoscopic surgery.

BACKGROUND: Preoperative computed tomography (CT)-guided localization of small lung nodules is important for accurate and efficient video-assisted thoracoscopic surgery (VATS). Resection of multiple small pulmonary nodules in one VATS procedure can aid in patient management. The aim of this study was to evaluate the usefulness of CT-guided Patent Blue V (PBV) dye localization in patients with multiple pulmonary nodules who underwent VATS.

METHODS: This retrospective study was conducted from January 2013 to December 2015. One hundred consecutive patients (59.9±10.5 years of age) with 217 nodules who underwent preoperative CT-guided PBV dye localization for multiple (2 to 4) nodules before VATS were enrolled.

RESULTS: The mean nodule size was 0.8±0.4 cm, with a mean depth from the pleura or fissure of 0.7±0.7 cm. The mean procedure duration was 50±20 minutes. The mean amount of injected PBV dye was 0.2±0.1 mL per nodule. The overall success rate was 99% by nodule. Failed localization of two nodules in two patients was due to poor dye visualization (n=1) and significant pneumothorax (n=1). Cases of hemorrhage (24%) were mild and asymptomatic, and none of the patients had hemoptysis. None of the cases of pneumothorax (40%) required chest tube placement before VATS. One (1%) patient developed anaphylaxis. The mean post-operative hospital stay was 6.4±4.4 days.

CONCLUSIONS: CT-guided PBV dye localization for multiple small pulmonary nodules before VATS is a safe, feasible, and accurate method with high success rate. This approach makes it easy to perform multiple nodule resections during one VATS operation.