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J Thorac Cardiovasc Surg 2006;132:320-324
© 2006 The American Association for Thoracic Surgery

General Thoracic Surgery

Usefulness and complications of computed tomography-guided lipiodol marking for fluoroscopy-assisted thoracoscopic resection of small pulmonary nodules: Experience with 174 nodules

Ken-ichi Watanabe, MD a , Hiroaki Nomori, MD, PhD b , * , Takashi Ohtsuka, MD, PhD a , Masahiro Kaji, MD, PhD a , Tsuguo Naruke, MD, PhD a , Keiichi Suemasu, MD, PhD a

a Department of Thoracic Surgery, Saiseikai Central Hospital Tokyo, Tokyo, Japan
b Graduate School of Medicine, Kumamoto University, Kumamoto, Japan

Received for publication February 22, 2006; revisions received April 2, 2006; accepted for publication April 20, 2006.

* Address for reprints: Hiroaki Nomori, MD, Department of Thoracic Surgery, Graduate School of Medicine, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan (Email: hnomori{at}qk9.so-net.ne.jp).

OBJECTIVE: Several techniques have been reported for the localization of small pulmonary nodules in thoracoscopic resection. In the present study we examined the usefulness and complications of computed tomography-guided lipiodol marking for thoracoscopic resection in our experience of 174 nodules.

METHODS: Computed tomography-guided lipiodol marking was performed on 174 nodules less than 30 mm in size. Of these nodules, 45 showed ground-glass opacity images and 129 showed solid images on computed tomography. The mean size of the nodules was 10 ± 6 mm (range, 2-30 mm), and their mean depth from the pleural surface was 10 ± 7 mm (range, 0-30 mm). One to 7 days before thoracoscopy, all of the nodules were marked with 0.4 to 0.5 mL of lipiodol by using computed tomography. The marked nodules were grasped with a ring-shaped forceps during fluoroscopy and resected by means of thoracoscopy.

RESULTS: All the nodules could be marked and localized by means of fluoroscopy as a clear spot during thoracoscopic surgery. Complications of the marking were chest pain requiring analgesia in 16 (11%) patients, hemosputum in 11 (6%) patients, pneumothorax in 30 (17%) patients, and hemopneumothorax in 1 (0.6%) patient. Eleven (6%) patients with pneumothorax required drainage, and the patient with hemopneumothorax required an emergency operation. No other complications were observed.

CONCLUSION: Lipiodol marking is a useful, safe, and inexpensive procedure for localizing ground-glass opacity lesions, small pulmonary nodules, or both for thoracoscopic resection.

Abbreviations and Acronyms CT = computed tomography; GGO = ground-glass opacity; TTNA = transthoracic needle aspiration






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