An original device for intraoperative detection of small indeterminate nodules†.

OBJECTIVES

The purpose of this study was to evaluate the efficiency of our newly designed tactile mechanoreceptor in detection of pulmonary lesions during thoracoscopy.

METHODS

Twenty-seven patients with peripheral undetermined subpleural solitary pulmonary lesions detected on computed tomography were included in a prospective non-randomized trial. All nodules from 7 to 18 mm in diameter were located deep in the lung parenchyma (≥ 10 mm from the lung surface). All patients underwent thoracoscopic exploration with diagnostic intent. Instrumental palpation with lung forceps was performed first, followed by thorough inspection of lung tissue with the tactile mechanoreceptor. This device is a metal tube 10 mm in diameter, which can be inserted into the pleural cavity via a standard 10-mm port. There is an elastic membrane on its working end, which deforms greatly if the palpated tissue has greater density. Intraoperatively, the surgeon pushed the targeted region of pulmonary tissue with the mechanoreceptor and carried out the measurement. The density of tissue characteristics was displayed with special software using colour change in real time. After detection of a pulmonary nodule, it was resected with endostaplers.

RESULTS

Instrumental palpation was successful in detection of pulmonary lesions in 10 (37%) patients and was confirmed with the tactile mechanoreceptor. In 12 (44%) patients, instrumental palpation failed to locate an intrapulmonary nodule, while the tactile mechanoreceptor facilitated finding the lesion and performing thoracoscopic lung resection in all these patients. Intraoperative histological examination confirmed benign disease in 8, metastatic lesion in 12 and primary lung cancer in 7 patients requiring thoracoscopic lobectomy. In 5 (19%) patients, neither forceps nor the tactile mechanoreceptor was able to detect any pulmonary lesion, necessitating mini-thoracotomy for finger palpation. The overall efficacy of the tactile mechanoreceptor in detection of pulmonary lesions was 81%, and of impalpable nodes 71%.

CONCLUSIONS

The tactile mechanoreceptor is an effective tool for detection of impalpable pulmonary lesions during thoracoscopy.