Localization of small pulmonary nodules for videothoracoscopic surgery

The aim of this study is to discuss and summarize the localization of small pulmonary nodules for videothoracoscopic surgery. Thirty-eight patients were selected, 22 men and 16 women, and they underwent video-assisted thoracoscopic surgery resection for small pulmonary nodules: 28 patients for small solitary pulmonary nodules and 10 patients for multiple small pulmonary nodules. In all cases, resection of the nodules was successful. Localization methods included: (i) computed tomography (CT)-guided methylene blue labelling for preoperative localization; (ii) a high-quality chest CT scan for preoperative localization; (iii) visual exploration, digital palpation and 'instrumental' palpation to locate the nodule; and (iv) endosonographic inspections of intraoperative localization. Using a combination of CT scan, digital palpation, methylene blue labelling and endosonographic inspections, all nodules were successfully localized and resected without significant complications. Video-assisted thoracoscopic surgery is an effective approach but the small lung nodules (especially those less than 1.0 cm in diameter) localized at thoracoscopic resection must be treated carefully. Combined imaging and thoracoscopic techniques may help identify small nodules.