Preoperative electromagnetic navigation bronchoscopy-guided one-stage multiple-dye localization for resection of...

Area of Science:

• Pulmonology
• Thoracic Surgery
• Interventional Pulmonology

Background:

• Subsolid pulmonary nodules present a challenge for surgical resection.
• Video-assisted thoracoscopic surgery (VATS) is a minimally invasive approach for lung nodule removal.
• Accurate localization is critical for successful resection of multiple small nodules.

Purpose of the Study:

• To evaluate the accuracy and safety of preoperative electromagnetic navigation bronchoscopy (ENB)-guided transbronchial dye marking for VATS resection of subsolid pulmonary nodules.
• To assess the feasibility of localizing multiple small subsolid pulmonary nodules using a single-stage ENB procedure.

Main Methods:

• A single-center pilot study involving patients with at least two small or subsolid pulmonary nodules.
• Intraoperative ENB-guided transbronchial injection of indigo carmine dye for multiple nodule localization.
• Immediate VATS for sublobar resection following dye localization.
• Verification of ENB-guided dye marking accuracy.

Main Results:

• ENB-guided one-stage multiple dye localization was performed on 18 pulmonary nodules in seven patients.
• Successful localization was achieved in 94.4% of nodules (17/18).
• The accuracy of ENB-guided dye marking was 88.2% (15/17), with no conversions to thoracotomy or operative mortalities. Mild intrabronchial bleeding occurred in one patient but resolved spontaneously. Lung function changes were tolerable.

Conclusions:

• ENB-guided one-stage transbronchial dye localization is an accurate and safe method for intraoperative identification of multiple subsolid pulmonary nodules.
• This technique facilitates VATS resection of small subsolid pulmonary nodules.
• Further large-scale prospective studies are warranted to confirm these findings.