Radiotracer-Guided Thoracoscopic Resection

Advancements in imaging technology have inspired the development of minimally-invasive approaches to thoracic disease. These improvements in imaging, however, have also introduced challenging diagnostic and treatment considerations in the identification of an increasing number of small pulmonary nodules. Video-assisted thoracic surgery (VATS) provides a platform for obtaining a tissue diagnosis or achieving a satisfactory resection in this setting. However, the utility of this technique is often limited by intra-operative localization.

This video describes a method for nodule localization that involves the injection of a technetium (Tc) radiotracer in or near the small lung nodule. A dedicated radioprobe (RMD Instruments, LLC, 44 Hunt St, Watertown, MA) with a 30-degree angled tip provides intra-operative guidance and localization of the preplaced, image-guided radiotracer marker. The described technique provides a reliable tissue diagnosis in 95% of patients and can be used to prevent thoracotomy in 50% of patients with benign disease (1,2).

References

1. Grogan EL, Jones DR, Kozower BD, Simmons WD, Daniel TM. Identification of small lung nodules: technique of radiotracer-guided thoracoscopic biopsy. Annals of Thoracic Surgery 2008, 85(2): S772-7.

2. Stiles BM, Altes TA, Jones DR et al. Clinical experience with radiotracer-guided thoracoscopic biopsy of small, indeterminate lung nodules. Annals of Thoracic Surgery 2006, 82(4): 1196-7.