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Computed tomography-guided patent blue vital dye localization of pulmonary nodules in uniportal thoracoscopy  Mong-Wei Lin, MD, PhD, Yao-Hui Tseng, MD,

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Presentation on theme: "Computed tomography-guided patent blue vital dye localization of pulmonary nodules in uniportal thoracoscopy  Mong-Wei Lin, MD, PhD, Yao-Hui Tseng, MD,"— Presentation transcript:

1 Computed tomography-guided patent blue vital dye localization of pulmonary nodules in uniportal thoracoscopy  Mong-Wei Lin, MD, PhD, Yao-Hui Tseng, MD, Yee-Fan Lee, MD, Min-Shu Hsieh, MD, Wei-Chun Ko, MD, Jo-Yu Chen, MD, Hsao-Hsun Hsu, MD, PhD, Yeun-Chung Chang, MD, PhD, Jin-Shing Chen, MD, PhD  The Journal of Thoracic and Cardiovascular Surgery  Volume 152, Issue 2, Pages e2 (August 2016) DOI: /j.jtcvs Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Algorithm for patient selection. CT, Computed tomography; VATS, video-assisted thoracoscopic surgery. The Journal of Thoracic and Cardiovascular Surgery  , e2DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 The radiologist performing CT-guided PBV dye localization.
The Journal of Thoracic and Cardiovascular Surgery  , e2DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 A, The arrow indicates a pure ground-glass nodule (GGN) in the right middle lobe. After intraoperative frozen section had confirmed a malignancy, the patient underwent additional uniportal video-assisted thoracoscopic surgery (VATS) lobectomy and systematic lymph node dissection. The final pathology report was invasive adenocarcinoma with a predominant lepidic pattern. B, After localization, the pleural surface of the localization route (hollow arrow) as well as the nodule site (solid arrow) were both marked with patent blue vital (PBV) dye. The Journal of Thoracic and Cardiovascular Surgery  , e2DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 A, Illustration of the localization procedure in patients with deep nodules. The nodule site or nearby location was first localized by PBV dye injection. The deep margin of the nodule is clearly visible during the operation. B, The subpleural lung parenchyma was subsequently localized by PBV dye injection. The Journal of Thoracic and Cardiovascular Surgery  , e2DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

6 Figure 5 A, Thoracoscopic view of the localized lung nodule site (arrow). The margin of the localized site is clear and is clearly visible intraoperatively even 245 minutes after the localization procedure in this case. B, Operative settings for uniportal VATS in our institute. One 3- to 4-cm incision was made in the anterior axillary line in the 5th intercostal space. The Journal of Thoracic and Cardiovascular Surgery  , e2DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

7 Figure E1 Surgical skills of uniportal video-assisted thoracoscopic surgery wedge resection for those lesions that were deep to the visceral pleural surface. The Journal of Thoracic and Cardiovascular Surgery  , e2DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

8 Figure E2 The frozen section (A) and permanent section (B) of the pulmonary nodules was clear for a pathologic diagnosis after PBV dye localization. The patient underwent uniportal VATS RML wedge resection for tissue proof at first. The frozen-section pathology report revealed invasive adenocarcinoma. Additional lobectomy for adequate section margin and systemic lymph node dissection were then performed. Permanent section pathology report revealed invasive adenocarcinoma with mixed lepidic (60%) and acinar (40%) patterns. The Journal of Thoracic and Cardiovascular Surgery  , e2DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

9 Figure E3 Nodules located at unsatisfactory sites for CT-guided hookwire localization were localized smoothly using the CT-guided PBV dye technique. A, The nodule (arrow) is located near the diaphragm. The pathology report revealed invasive adenocarcinoma with mixed acinar (40%) and lepidic (60%) patterns. B, The nodule (arrow) is located in the apex area. The pathology report revealed fibrosis. C, The nodule (arrow) is located in the paraspinal area. The pathology report revealed invasive adenocarcinoma with a predominantly papillary pattern. D, The nodule (arrow) is located near the aortic arch. The pathology report revealed invasive adenocarcinoma with a predominantly lepidic pattern. E, The nodules (arrows) are located in the bilateral lung fields, and the left nodule is deep in the lung parenchyma. The pathology report revealed invasive adenocarcinoma with mixed acinar (40%) and lepidic (60%) patterns for the left upper lobe nodule and adenocarcinoma in situ for the right lower lobe nodule. The Journal of Thoracic and Cardiovascular Surgery  , e2DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

10 Thoracoscopic view of the indeterminate lung nodule localized by CT-guided PBV dye.
The Journal of Thoracic and Cardiovascular Surgery  , e2DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

11 Video 1 The procedure for CT-guided PBV dye localization and uniportal VATS wedge resection. Video available at The Journal of Thoracic and Cardiovascular Surgery  , e2DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

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