Electromagnetic navigation bronchoscopy guided injection of methylene blue combined with hookwire for preoperative localization of small pulmonary lesions in thoracoscopic surgery

Abstract

Video-assisted thoracoscopic surgery (VATS) has been widely used in the resection of small pulmonary lesions in the clinical practice. The accurate preoperative localization of small pulmonary lesions is significant to guide the operation. We report a thoracoscopic pulmonary wedge resection with electromagnetic navigation bronchoscopy (ENB) guided injection of methylene blue combined with hookwire to localize the small pulmonary lesion in a 50-year-old woman. We successfully performed VATS followed by the combined localization of these two methods. This localization method has a higher accuracy and fewer complications, which can effectively guide the surgical resection.

Keywords: Electromagnetic navigation bronchoscopy (ENB); localization; small pulmonary lesions; video-assisted thoracoscopic surgery (VATS).

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1

(A) It was the preoperative CT scan of the patient, which showed a ground glass opacity (white arrow) in the right upper lobe; (B) it was the real-time navigation screen when the distance between the sensor probe and the lesion was nearest; (C) injection of methylene blue through extended working channel (EWC) under the guidance of X fluoroscopy; (D) it was the chest CT scan after injection of methylene blue, some floccules like cloud (red arrow) occurred after injection of methylene blue; (E) the lesion could be seen located in the region between methylene blue and the hookwire during the process of the VATS; (F) the pathology result showed it was adenocarcinoma (40×).

Figure 2

Video of the registration and navigation of ENB (8). The time (00:00:00 to 00:01:08) is the registration phase. The registration point is main carina (MC), right upper lobe (RUL), right middle lobe (RML), right lower lobe (RLL), left upper lobe (LUL), left lower lobe (LLL) in sequence. The following time (00:01:09 to 00:02:39) is the navigation phase. The nearest distance from the locatable guide (LG) to the target (t1 in the video) is 1.0 cm. It is considered to be arrived at the accuracy location. Available online: http://www.asvide.com/articles/750