Localization Technique Using Mixture of Indigo Carmine and Lipiodol of Pulmonary Nodule via Bronchoscopic Navigation

Abstract

Background and Objectives: As the number of minimally invasive surgeries, including video-assisted thoracoscopic surgery, increases, small, deeply located lung nodules are difficult to visualize or palpate; therefore, localization is important. We studied the use of a mixture of indigo-carmine and lipiodol, coupled with a transbronchial approach-to achieve accurate localization and minimize patient discomfort and complications. Materials and Methods: A total of 60 patients were enrolled from May 2019 to April 2022, and surgery was performed after the bronchoscopy procedure. Wedge resection or segmentectomy was performed, depending on the location and size of the lesion. Results: In 58/60 (96.7%) patients, the localization of the nodules was successful after localization, and 2/60 required c-arm assistance. None of the patients complained of discomfort during the procedure; in all cases, margins were found to be free from carcinoma, as determined by the final pathology results. Conclusions: We recommend this localization technique using mixture of indigo carmine and lipiodol, in concert with the transbronchial approach, because the procedure time is short, patient's discomfort is low, and success rate is high.

Keywords: bronchoscopy; indigo carmine; lipiodol; localization; pulmonary nodule; video-assisted thoracoscopic surgery.

Figure 1

Preoperative CT scan and transbronchial marking procedure. The location and type of nodules (white arrow) was identified through CT before surgery; based on this, localization was performed using MIL via tranbronchial approach.

Figure 2

Video-assisted thoracoscopic image of nodule marked with MIL and resected lung. If localization is successful, the location can be easily identified through a video-assisted thoracoscopic image in the operating room.