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

Background. The pulmonary nodules have become the major indication of video -assisted thoracic surgery (VATS). Recently, several preoperative or intrao perative techniques for identifying small or deeply seated pulmonary nodule s have facilitated thoracoscopic resection. We describe the new technique f or detecting difficult lesions. Methods. Preoperatively, we marked the visceral pleura near the pulmonary n odules with dye, simultaneously injected contrast media (1 water-soluble Op tiray [Mallinckrodt Medical Inc, Quebec, Canada], 18 barium sulfate, 11 Lip iodol [Laboratoire Guerbet, Aulnay-sous-Bois, France]) into or around the n odule under computed tomography (CT) guidance. During VATS, we were able to easily and accurately detect and resect all the nodules localized with con trast media, of which the radiopacity was visualized on the portable fluoro scopic monitor. Results. Between February 1996 and December 1998, we thoracoscopically rese cted 30 nodules in 28 patients (13 were women; age, 53 a 14 years). The res ected 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 w as benign in 20 and malignant in 10 (six primary cancers of lung and four m etastatic cancers). There were only minor complications related CT localiza tion. Conclusions. This new technique can help the surgeons detect and resect the difficult lesions with safety and rapidity by VATS without thoracotomy. (C ) 1999 by The Society of Thoracic Surgeons.