Willekes Lourens, Boutros Cherif, Goldfarb Michael A
Department of Surgery, Monmouth Medical Center, NJ, USA.
J Cardiothorac Surg. 2008 Mar 19;3:13. doi: 10.1186/1749-8090-3-13.
Video-assisted thoracic surgery (VATS) has become routine and widely accepted for the removal of solitary pulmonary nodules of unknown etiology. Thoracosopic techniques continue to evolve with better instruments, robotic applications, and increased patient acceptance and awareness. Several techniques have been described to localize peripheral pulmonary nodules, including pre-operative CT-guided tattooing with methylene blue, CT scan guided spiral/hook wire placement, and transthoracic ultrasound. As pulmonary surgeons well know, the lung and visceral pleura may appear featureless on top of a pulmonary nodule.
This paper presents a rapid, direct and inexpensive approach to peripheral lung lesion resection by marking the lung parenchyma on top of the nodule using direct methylene blue injection.
In two patients with peripherally located lung nodules (n = 3) scheduled for VATS, we used direct methylene blue injection for intraoperative localization of the pulmonary nodule. Our technique was the following: After finger palpation of the lung, a spinal 25 gauge needle was inserted through an existing port and 0.1 ml of methylene blue was used to tattoo the pleura perpendicular to the localized nodule. The methylene blue tattoo immediately marks the lung surface over the nodule. The surgeon avoids repeated finger palpation, while lining up stapler, graspers and camera, because of the visible tattoo. Our technique eliminates regrasping and repalpating the lung once again to identify a non marked lesion.
Three lung nodules were resected in two patients. Once each lesion was palpated it was marked, and the area was resected with security of accurate localization. All lung nodules were resected in totality with normal lung parenchymal margins. Our technique added about one minute to the operative time. The two patients were discharged home on the second postoperative day, with no morbidity.
VATS with intraoperative tattooing is a safe, easy, and accurate technique to streamline and efficiently resect solitary pulmonary nodules.
电视辅助胸腔镜手术（VATS）已成为切除病因不明的孤立性肺结节的常规且被广泛接受的方法。随着器械的改进、机器人应用以及患者接受度和认知度的提高，胸腔镜技术不断发展。已经描述了几种定位外周肺结节的技术，包括术前CT引导下用亚甲蓝纹身、CT扫描引导下放置螺旋/钩丝以及经胸超声检查。正如胸外科医生所知，在肺结节上方，肺和脏胸膜可能看起来没有特征。
本文介绍了一种通过直接注射亚甲蓝标记结节上方的肺实质来快速、直接且廉价地切除外周肺病变的方法。
在两名计划进行VATS的外周肺结节患者（共3个结节）中，我们使用直接注射亚甲蓝进行术中肺结节定位。我们的技术如下：在手指触诊肺之后，将一根25号脊椎穿刺针通过现有的切口插入，使用0.1毫升亚甲蓝垂直于定位的结节对胸膜进行纹身。亚甲蓝纹身立即标记了结节上方的肺表面。由于有可见的纹身，外科医生在排列吻合器、抓钳和摄像头时避免反复手指触诊。我们的技术消除了再次抓持和触诊肺以识别未标记病变的情况。
两名患者共切除了3个肺结节。每个病变一旦被触诊就进行了标记，并且在准确的定位保障下切除了该区域。所有肺结节均被完整切除，肺实质边缘正常。我们的技术使手术时间增加了约一分钟。两名患者术后第二天出院，无并发症。
术中纹身的VATS是一种安全、简便且准确的技术，可简化并有效切除孤立性肺结节。
