Background Small peripheral pulmonary nodules, which are usually deep-seated with no visual markers on the pleural surface, are often difficult to locate during surgery. At present, CT-guided percutaneous techniques are used to locate pulmonary nodules, but this method has many limitations. Thus, we aimed to evaluate the accuracy and feasibility of electromagnetic navigational bronchoscopy (ENB) with pleural dye to locate small peripheral pulmonary nodules before video-associated thoracic surgery (VATS).
Methods The ENB localisation procedure was performed under general anaesthesia in an operating room. Once the locatable guide wire, covered with a sheath, reached the ideal location, it was withdrawn and 0.2–1.0 mL of methylene blue/indocyanine green was injected through the guide sheath. Thereafter, 20–60 mL of air was instilled to disperse the dye to the pleura near the nodules. VATS was then performed immediately.
Results Study subjects included 25 patients with 28 nodules. The mean largest diameter of the pulmonary nodules was 11.8 mm (range, 6.0–24.0 mm), and the mean distance from the nearest pleural surface was 13.4 mm (range, 2.5–34.9 mm). After the ENB-guided localisation procedure was completed, the dye was visualised in 23 nodules (82.1%) using VATS. The average duration of the ENB-guided pleural dye marking procedure was 12.6 min (range, 4–30 min). The resection margins were negative in all malignant nodules. Complications unrelated to the ENB-guided localisation procedure occurred in two patients, including one case of haemorrhage and one case of slow intraoperative heart rate.
Conclusion ENB can be used to safely and accurately locate small peripheral pulmonary nodules and guide surgical resection.
Trial registration number ChiCTR1900021963.
- Electromagnetic navigation bronchoscopy (ENB)
- dye marking
- peripheral pulmonary nodules (PPNs)
- Video-associated thoracic surgery (VATS）
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Contributors All authors: study concept and design. Final approval of the manuscript: L-lW, JL: acquisition of data, and drafted and revised the manuscript. J-yS: technical guidance. B-fH, J-hC, X-lG, P-pC: performed the ENB-guided localisation procedure. W-zZ, R-qL: performed VATS.
Funding This work was supported by the National Key R&D Program of China (no 2017YFC0112700).
Competing interests None declared.
Patient consent for publication Obtained.
Ethics approval The protocol was approved by the local research ethics committee of the Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences). Informed consent to undergo ENB-guided pleural dye marking was obtained from all patients.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Data may be obtained by emailing firstname.lastname@example.org.
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