Tay Jun H, Wallbridge Peter D, Larobina Marco, Russell Prudence A, Irving Louis B, Steinfort Daniel P
Departments of *Respiratory & Sleep Medicine †Cardiothoracic Surgery, Royal Melbourne Hospital, Parkville ‡Department of Pathology, St Vincent's Hospital, Fitzroy, Victoria, Australia.
J Bronchology Interv Pulmonol. 2016 Jul;23(3):245-50. doi: 10.1097/LBR.0000000000000214.
Limited (wedge) resection of pulmonary lesions is frequently performed as a diagnostic/therapeutic procedure. Some lesions may be difficult to locate thoracoscopically with conversion to open thoracotomy or incomplete resection being potential limitations to this approach. Multiple methods have been described to aid video-assisted thoracoscopic surgical (VATS) wedge resection of pulmonary nodules, including hookwire localization, percutaneous tattoo, or intraoperative ultrasound. We report on our experience using electromagnetic navigation bronchoscopic dye marking of small subpleural lesions to aid VATS wedge resection.
A retrospective cohort study of consecutive patients undergoing VATS wedge resection of peripheral lesions. Preoperative bronchoscopy with electromagnetic navigation was utilized to guide a 25 G needle to within/adjacent to the target lesion with injection of 1 mL of methylene blue or indigo carmine under fluoroscopic vision.
Six patients underwent bronchoscopic marking of peripheral pulmonary lesions, navigation deemed successful in all patients, with no procedural complications. Surgery was performed within 24 hours of bronchoscopic marking. Pleural staining by dye was visible thoracoscopically in all 6 lesions either adjacent to or overlying the lesion. All lesions were fully excised with wedge resection. Pathologic examination confirmed accuracy of dye staining.
Electromagnetic navigation bronchoscopic dye marking of peripheral lesions is feasible, without complications commonly associated with percutaneous marking procedures. Further experience is required but early findings suggest that this method may have utility in aiding minimally invasive resection of small subpleural lesions.
肺病变的局限性（楔形）切除术常作为一种诊断/治疗手段。一些病变可能难以通过胸腔镜定位，转为开胸手术或切除不完全是这种方法的潜在局限性。已经描述了多种辅助电视辅助胸腔镜手术（VATS）楔形切除肺结节的方法，包括钩丝定位、经皮纹身或术中超声。我们报告了使用电磁导航支气管镜对小的胸膜下病变进行染料标记以辅助VATS楔形切除的经验。
对连续接受VATS楔形切除周围病变的患者进行回顾性队列研究。术前使用电磁导航支气管镜引导一根25G针在透视下将1mL亚甲蓝或靛胭脂注射到目标病变内或其附近。
6例患者接受了周围肺病变的支气管镜标记，所有患者导航均成功，无手术并发症。手术在支气管镜标记后24小时内进行。在所有6个病变中，胸腔镜下均可看到染料对胸膜的染色，其位于病变附近或上方。所有病变均通过楔形切除完全切除。病理检查证实了染料染色的准确性。
电磁导航支气管镜对周围病变进行染料标记是可行的，没有经皮标记程序常见的并发症。需要进一步的经验，但早期结果表明该方法可能有助于微创切除小的胸膜下病变。
