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Eur J Cardiothorac Surg 1999;14:265-270
© 1999 Elsevier Science NL
a Department of Surgery, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
b Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Received 13 October 1997; received in revised form 5 April 1998; accepted 12 May 1998.
Corresponding author. Tel.: +41 021 3142351; fax: +41 024 4688623; e-mail: michel.suter@chuv.hospvd.ch
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.
Key Words: Thoracoscopy • Pulmonary nodule • Methylene-blue
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