Abstract
Introduction
The number of cases of wedge resection of small-sized pulmonary nodules performed under video-assisted thoracoscopic surgery (VATS) is increasing. Computed tomography (CT)-guided marking with hook wires has been used to locate the nodules that are not identifiable under VATS. However, this method is invasive and is associated with a risk of complications.
Methods
We evaluated the usefulness of marking the pleural surface above the nodule using crystal violet for 22 small-sized pulmonary nodules. Following the collapse of the lung, a long stick with a cotton tip dipped in crystal violet was inserted from the thoracic port or a small thoracotomy, and was placed against the inside of the chest wall right above the nodule with reference to the preoperative CT image. The lung was then expanded, and the crystal violet-infiltrated tip stained the visceral pleura. Regardless of the marking point, wedge resection of the lung was performed. To evaluate the accuracy of the marking, we measured the distance from the center of the marking to the point on the visceral pleural nearest to the nodule (DMN) in the resected lung specimen.
Results
This marking method caused no morbidity during or after the operation. The DMN ranged between 0 and 50 mm (mean ± SD 18.2 ± 12.6 mm). In 18 of 22 cases (81.8 %), the DMN was 20 mm or less.
Conclusions
The intraoperative marking method using crystal violet was performed with reasonable accuracy. It also caused no morbidity. It was easy and non-invasive. This method can be used in the cases in which CT-guided percutaneous marking is not feasible due to the nodule’s location.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Munden RF, Pugatch RD, Liptay MJ, Sugarbaker DJ, Le LU. Small pulmonary lesions detected at CT: clinical importance. Radiology. 1997;202:105–10.
Mack MJ, Hazelrigg SR, Landreneau RJ, Acuff TE. Thoracoscopy for the diagnosis of the indeterminate solitary pulmonary nodule. Ann Thorac Surg. 1993;56:825–30 (discussion 30-2).
Suzuki K, Nagai K, Yoshida J, Ohmatsu H, Takahashi K, Nishimura M, et al. Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodules: indications for preoperative marking. Chest. 1999;115:563–8.
Mack MJ, Gordon MJ, Postma TW, Berger MS, Aronoff RJ, Acuff TE, et al. Percutaneous localization of pulmonary nodules for thoracoscopic lung resection. Ann Thorac Surg. 1992;53:1123–4.
Kerrigan DC, Spence PA, Crittenden MD, Tripp MD. Methylene blue guidance for simplified resection of a lung lesion. Ann Thorac Surg. 1992;53:163–4.
Horan TA, Pinheiro PM, Araujo LM, Santiago FF, Rodriques MR. Massive gas embolism during pulmonary nodule hook wire localization. Ann Thorac Surg. 2002;73:1647–9.
Sakiyama S, Kondo K, Matsuoka H, Yoshida M, Miyoshi T, Yoshida S, et al. Fatal air embolism during computed tomography-guided pulmonary marking with a hook-type marker. J Thorac Cardiovasc Surg. 2003;126:1207–9.
Matsuguma H, Nakahara R, Kondo T, Kamiyama Y, Mori K, Yokoi K. Risk of pleural recurrence after needle biopsy in patients with resected early stage lung cancer. Ann Thorac Surg. 2005;80:2026–31.
Sawabata N, Ohta M, Maeda H. Fine-needle aspiration cytologic technique for lung cancer has a high potential of malignant cell spread through the tract. Chest. 2000;118:936–9.
Yoshida Y, Inoh S, Murakawa T, Ota S, Fukayama M, Nakajima J. Preoperative localization of small peripheral pulmonary nodules by percutaneous marking under computed tomography guidance. Interact Cardiovasc Thorac Surg. 2011;13:25–8.
Miyoshi T, Kondo K, Takizawa H, Kenzaki K, Fujino H, Sakiyama S, et al. Fluoroscopy-assisted thoracoscopic resection of pulmonary nodules after computed tomography-guided bronchoscopic metallic coil marking. J Thorac Cardiovasc Surg. 2006;131:704–10.
Echfeld U, Dietrich A, Ott R, Kloeppel R. Video-assisted thoracoscopic surgery for pulmonary nodules after computed tomography-guided marking with a spiral wire. Ann Thorac Surg. 2005;79:313–6.
Endo M, Kotani Y, Satouchi M, Takada Y, Sakamoto T, Tsubota N, et al. CT fluoroscopy-guided bronchoscopic dye marking for resection of small peripheral pulmonary nodules. Chest. 2004;125:1747–52.
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;132:210–4.
Iwasaki Y, Nagata K, Yuba T, Hosogi S, Kohno K, Ohsugi S, et al. Fluoroscopy-guided barium marking for localizing small pulmonary lesions before video-assisted thoracic surgery. Respir Med. 2005;99:285–9.
Ikeda K, Nomori H, Mori T, Kobayashi H, Iwatani K, Yoshimoto K, et al. Impalpable pulmonary nodules with ground-glass opacity: success for making pathologic sections with preoperative marking by lipiodol. Chest. 2007;131:502–6.
Santambroqio R, Montorsi M, Bianchi P, Mantovani A, Ghelama F, Mezzetti M. Intraoperative ultrasound duing thoracoscopic procedures for solitary pulmonary nodules. Ann Thorac Surg. 1999;68:218–22.
Nishida T, Fujii Y, Akizuki K. Preoperative marking for peripheral pulmonary nodules in thoracoscopic surgery: a new method without piercing the pulmonary parenchyma. Eur J Cardiothorac Surg. 2013;44:1131–3.
Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.
Tomiyama N, Yasuhara Y, Nakajima Y, Adachi S, Arai Y, Kusumoto M, et al. CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol. 2006;59:60–4.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Okuda, K., Yano, M., Sasaki, H. et al. A safe method for marking small pulmonary nodules with crystal violet. Surg Today 45, 871–875 (2015). https://doi.org/10.1007/s00595-014-1048-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-014-1048-4