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Geometric mapping of small pulmonary nodules
Mitsuhiro Kamiyoshihara, Takashi Ibe, Natsuko Kawatani, Hitoshi Igai.
Maebashi Red Cross Hospital, Maebashi, Japan.

OBJECTIVE: Computed tomography (CT)-guided lung needle marking is useful to identify pulmonary nodules. However, certain complications infrequently trigger severe after-effects or death. We thus present a convenient and safe method by which small pulmonary nodules can be identified using a certain dye (Pyoctanine®; 2% [w/v] gentian violet).
METHODS: The Figures show that a patient is initially placed in the lateral position identical to the operative position. Under CT guidance, a “magic marker” is used to identify skin above the pulmonary nodule. During the operation, the chest wall is punctured at that mark using a needle loop retractor (a Mini Loop Retractor II). A swab saturated in a dye solution and attached to a silk thread is passed through the loop. The loop and string are subsequently retracted. When the lung is inflated, a dye-stamp is apparent on the lung surface above the nodule.
RESULTS: We used this technique to treat 35 lesions of 34 patients presenting from April 2014 to May 2015. The average tumor diameter was 7 mm. If the scapula, any vertebra, or the clavicle compromised access to a nodule, we used our geometric technique to locate that nodule (Figures). All lesions were identified via thoracoscopy, all nodules were constrained by ring forceps, and wedge resections (using staplers) followed. All lesions lay very close to the staple markings, as judged by finger or instrument palpation. No complication was encountered. The advantages of our technique are that it is simple and easy, air embolism is not an issue, skin marking is rapid, safety is absolutely assured, and skin marking does not require hospitalization. There are no disadvantages.
CONCLUSIONS: Our method locates nodules, defines the margins of the cut line upon anatomical segmentectomy, indicates where skin incisions are required, and identifies impalpable nodules (such as those that are “ground-glass” in nature), aiding not only lung resection but also provision of frozen sections to the pathologist.

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