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CT-guided methylene-blue labelling before thoracoscopic resection of pulmonary nodules

Vandoni, Riccardo E. ; Cuttat, Jean-François ; Wicky, Stéphane ; Suter, Michel

In: European Journal of Cardio-Thoracic Surgery, 1998, vol. 14, no. 3, p. 265-270

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    Titre
    • CT-guided methylene-blue labelling before thoracoscopic resection of pulmonary nodules
    Auteur
    • Vandoni, Riccardo E.. Department of Surgery, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
    • Cuttat, Jean-François. Department of Surgery, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
    • Wicky, Stéphane. Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
    • Suter, Michel. Department of Surgery, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Journal of Cardio-Thoracic Surgery, 1998, vol. 14, no. 3, p. 265-270. Elsevier Science B.V.
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:297559
    Summary
    Objective: Evaluation of the efficiency of our technique of methylene-blue labelling of pulmonary nodules to facilitate thoracoscopic recognition and excision. Design: Patients with a peripheral pulmonary nodule smaller than 2.5 cm and not in contact with the visceral pleura were included. Under tomodensitometric guidance, the nodules were labelled with methylene-blue within hours before thoracoscopic wedge resection. If frozen section revealed a primary bronchial carcinoma, thoracotomy and classical resection were performed during the same anesthesia. Results: Between July 1992 and August 1996, 54 nodules were removed in 51 patients. Labelling was performed between 75 and 270 min before surgery and was complicated in 13 patients (25.4%) by a small pneumothorax without any clinical consequence. Labelling allowed successful thoracoscopic recognition of 50 nodules (92%) and thoracoscopic wedge resection was possible in all but one cases (91%). Five patients (9%) required thoracotomy. Histology showed a benign lesion in 22 cases, a primary lung carcinoma in 17 and a metastases in 15. Twenty of the 22 benign nodules (91%) were removed without thoracotomy. According to the protocol, 13 patients with a primary lung tumour underwent lobectomy during the same session. There was no mortality nor morbidity amongst patients who had thoracoscopy only. Conclusions: Our technique of labelling peripheral pulmonary nodules with methylene-blue is very effective and is not associated with any relevant complication. Thoracoscopic excision and diagnosis is possible in more than 90% of the cases. We therefore recommend this simple, low-cost and reliable technique for nodules not in contact with the visceral pleura before thoracoscopic wedge resection