How Bronchoscopic Dye Marking Can Help Minimally Invasive Lung Surgery

Abstract

In the era of increasing availability of high-resolution chest computed tomography, the diagnosis and management of solitary pulmonary nodules (SPNs) has become a common challenging clinical problem. Meanwhile, surgical techniques have improved, and minimally invasive approaches such as robot- and video-assisted surgery are becoming standard, rendering the palpation of such lesions more difficult, not to mention pure ground-glass opacities, which cannot be felt even in open surgery. In this article, we explore the role of bronchoscopy in helping surgeons achieve successful minimally invasive resections in such cases.

Keywords: EMB; VAL-MAP; bronchoscopy; indocyanine green; methylene blue; minimally invasive surgery; radial EBUS; solitary pulmonary nodule.

Figure 1

Number of segmentectomies based on a surgical approach in France between 2009 and September 2021. Data extracted from Epithor database [11], in red: minimally invasive surgeries.

Figure 2

Dye marking using ENB, courtesy of Dr. Agathe Seguin-Givelet.

Figure 3

Dye marking using virtual bronchoscopy + R EBUS, courtesy of Dr. Samy Lachkar.