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Related Experiment Video

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CT-guided Preoperative Localization of Pulmonary Nodules Using a Glucose Test and Tissue Adhesive
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A safe method for marking small pulmonary nodules with crystal violet.

Katsuhiro Okuda1, Motoki Yano, Hidefumi Sasaki

  • 1Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Science, 1 Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya, 467-8601, Japan.

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Crystal violet marking of small pulmonary nodules before video-assisted thoracoscopic surgery (VATS) is a safe and effective alternative to invasive hook wire methods. This non-invasive technique offers reasonable accuracy for locating nodules during VATS wedge resections.

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Area of Science:

  • Thoracic Surgery
  • Surgical Oncology
  • Pulmonary Medicine

Background:

  • Video-assisted thoracoscopic surgery (VATS) is increasingly used for wedge resections of small pulmonary nodules.
  • Computed tomography (CT)-guided hook wire marking is a common but invasive method for locating non-identifiable nodules.
  • Hook wire marking carries risks of complications and invasiveness.

Purpose of the Study:

  • To evaluate the accuracy and safety of intraoperative crystal violet marking of the visceral pleura for guiding VATS wedge resections.
  • To assess crystal violet marking as a less invasive alternative to CT-guided percutaneous marking.

Main Methods:

  • Crystal violet dye was applied to the visceral pleura overlying 22 small pulmonary nodules using a cotton-tipped applicator guided by preoperative CT.
  • The lung was re-expanded, staining the pleura, and wedge resection was performed.
  • Accuracy was assessed by measuring the distance from the marking center to the nearest nodule point (DMN) in resected specimens.

Main Results:

  • The crystal violet marking method resulted in no intraoperative or postoperative morbidity.
  • The mean distance (DMN) from the marking to the nodule was 18.2 ± 12.6 mm.
  • In 81.8% of cases (18/22), the DMN was 20 mm or less, indicating reasonable accuracy.

Conclusions:

  • Intraoperative crystal violet pleural marking is a safe, non-invasive, and accurate method for guiding VATS wedge resections of small pulmonary nodules.
  • This technique is particularly useful when CT-guided percutaneous marking is not feasible.
  • Crystal violet marking offers a practical and effective alternative for improving nodule localization in thoracic surgery.