Thoracoscopic small pulmonary nodule detection using computed tomography-guided cutaneous marking and pleural marking

Area of Science:

• Thoracic Surgery
• Medical Imaging
• Oncology

Background:

• Computed tomography (CT) enables detection of small pulmonary nodules.
• Video-assisted thoracoscopic surgery (VATS) is common for wedge resection of these nodules.
• Locating small tumors via palpation during VATS can be challenging due to small access ports.

Purpose of the Study:

• To describe a novel method for marking the exact location of small pulmonary tumors before surgery.
• To enhance tumor identification during VATS procedures.

Main Methods:

• A CT-guided technique involved marking the skin directly above the tumor.
• A pleural marker with dye was placed on the parietal pleura below the skin mark using a catheter needle.
• Accuracy was assessed by measuring the distance from the skin mark to the visceral pleura closest to the tumor.

Main Results:

• The mean distance between the skin mark center and the closest visceral pleura was 12.4 mm.
• In 92% of cases (47/51), the tumor was within 30 mm of the marking site.
• All tumors were completely resected with no observed morbidity; one case required conversion to open surgery.

Conclusions:

• The CT-guided cutaneous and pleural marking method accurately identifies tumor location.
• This technique simplifies tumor palpation during VATS.
• The procedure is easy to apply, safe, and accurate, supporting its clinical implementation.