Localization of pulmonary nodules before thoracoscopic surgery: value of percutaneous staining with methylene blue.

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Abstract
Video-assisted thoracic surgery (VATS) is a new procedure that makes it possible to see the intrathoracic organs and to resect pulmonary nodules without thoracotomy. Preoperative localization of small nodules that may not be visible or palpable during VATS is desirable. Percutaneous placement of spring hookwires is widely used to localize pulmonary nodules before VATS; infrequently, the adjacent lung parenchyma is also stained with methylene blue. The purpose of this study was to evaluate the effectiveness of methylene blue staining of pulmonary nodules without placement of a hookwire.Fifteen pulmonary nodules in 15 patients were localized preoperatively under CT guidance by using techniques identical to those for CT-guided fine-needle aspiration of pulmonary nodules. Approximately 0.3 ml of methylene blue dye was injected into the nodule with a 22-gauge Chiba needle to stain the nodule, the needle pathway, and the visceral pleura. In two patients, a hookwire also was placed. All patients had solitary nod...

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