A Series Of Studies On The Application Of Methylene Blue Staining Methods For Small Chest Tumors In Thoracoscopic Surgery

Objective Pulmonary segmentectomy is being increasingly used to resect small lung nodules.However,identifying the intersegmental plane is difficult.To evaluate the feasibility and safety of methylene blue staining methods for identifying lung intersegmental borders in video-assisted thoracoscopic segmentectomy.Methods The study was approved by the institutional review board of Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology.Informed consent was obtained.Firstly,target lung bronchi methylene blue staining was performed on the isolated lung lobe undergoing conventional lobectomy for lung diseases,and then bronchi methylene blue staining was performed to determine the intersegment boundary in video-assisted thoracoscopic segmentectomy.Staining of lung segments in vitro,a 50-m L syringe was used to inject 20 m L of 0.1% methylene blue into the bronchus.Between October 2013 and September 2017,58 patients with lung disease underwent thoracoscopic anatomic segmentectomy.After division the vein,bronchus and artery of the target segments,about 20 ml diluted solution of methylene blue was slowly injected into the target bronchus.We observed whether the boundary between the stained target segment and the adjacent unstained lung segment was clear,and observed whether the chest tube drainage,sputum,and urine were blue dyed after operation.Results The target pulmonary segments stained blue immediately after the injection of methylene blue through the segmental bronchus.Clear boundaries were visible between the bluecolored target pulmonary segments and the adjacent unstained segments.The segments stained well,and no dispersion into the pleural surface or lung parenchyma 30 min after injection.VATS was performed uneventfully in 58 patients,The mean time of thoracoscopic methylene blue staining was 3.0±0.6min.The target lung segments stained blue immediately after injection of methylene blue.Clear borders were visible between the blue colored target pulmonary segments and the adjacent unstained segments.The intersegmental borders could be clearly identified both on the pleural surface and in the lung parenchyma.All methylene blue staining were successfully completed.Endoscopic staplers were used to resect the target segment along the boundary.Mean in-hospital days was 9.2±1.4d.No perioperative deaths or major complications occurred.Conclusion It is a feasible and safe methylene blue staining method for identifying the lung intersegmental borders in video-assisted thoracoscopic segmentectomy.Methylene blue staining method is simple and convenient.This methylene blue staining method should enable thoracic surgeons to perform thoracoscopic segmentectomy easily and precisely,and its widespread adoption may be worthwhile.Objective: Anatomic segmentectomy is a common operation in thoracic surgery,and one of the difficulties is how to accurately determine the boundaries between the lung segments.A safe and feasible transbronchial methylene blue staining method for identifying the intersegmental borders has been reported by us.For patients with bronchial obstruction is not suitable for bronchial injection of methylene blue,a new method through the target segment vascular methylene blue staining to determine the intersegmental border.Due to the variability of the target vein and the presence of more traffic branches between the lung segments vein,staining is not conducive to accurately determine the boundary of the pulmonary segment.Therefore,this article explores the feasibility of Pulmonary artery approach methylene blue staining to determine the intersegmental borders.Methods: Pulmonary artery staining tests were performed on isolated lobes resected by lobectomy to explore the feasibility of pulmonary artery methylene blue staining.Pulmonary artery methylene blue staining was then performed in an anatomical segmentectomy for the appropriate patient.Between October 2013 and September 2017,71 patients required anatomical segmentectomy were divided into two groups.Different routes of methylene blue staining were used to determine the boundaries between the lung segments(58 in bronchial staining and 13 in arterial staining).After division the vein,artery and bronchus of the target segments,about 20 ml diluted solution of methylene blue was slowly injected into the target bronchus.In the target pulmonary artery staining group,the diluted methylene blue solution is slowly injected into the target segment artery,and the ligature is ligated to the distal segment of pulmonary artery to prevent methylene blue solution from spilling through the pinhole.Results: Pulmonary artery methylene blue staining tests demonstrated that injection of methylene blue through the target segment arteries was as good as the target segment bronchus in isolated lungs.After injection of methylene blue in the two groups,the target lung segment were stained blue immediately in the anatomical segmentectomy.On the pleural surface and in the lung parenchyma can clearly determine the intersegmental borders.The target segment of bronchial staining process takes an average time was 3.0±0.6min,the target segment artery staining process takes an average time was 5.0±1.7min,the surgery were successfully completed.Postoperative chest tube drainage fluid were not stained blue in both groups,postoperative sputum color normal,no abnormal urine staining.No methylene blue perioperative deaths or major complications occurred.Conclusion: Methylene blue staining method can clearly determine the intersegmental borders on the pleural surface and in the lung parenchyma.Pulmonary artery methylene blue staining and bronchial methylene blue staining can accurately determine the boundary between the lung segments.Bronchial methylene blue staining method is simple,suitable for most of the segmentectomy.Pulmonary artery methylene blue staining method is morecomplex,suitable for bronchial obstruction and other unsuitable bronchial staining.Pulmonary artery methylene blue staining does not require special equipment,safe and feasible.Objective: To evaluate the clinical value of CT-guided localization of small pulmonary nodules with methylene blue medical glue or autologous blood under uniportal video-assisted thoracoscope surgery.Method: Retrospective observational data for 37 patients who underwent CT-guided localization with methylene blue medical glue or autologous blood in department of thoracic surgery at Wuhan Tongji hospital from September 2015 till now.Result:CT-guided localization of small pulmonary nodules with methylene blue medical glue or autologous blood was successful in all patients(100%).The mean time of puncturing was 20±4.7min.There was 1 case of pneumothorax,1 case of hematopneumothorax.None of them had Hemoptysis or pleural reaction.The 37 patients first performed wedge resection according to the location.The average time from insertion of the thoracoscope to specimen removal was 7.0 ± 2.1min.No thoracotomy.All the patients recovered smoothly after operation and no serious complications such as major bleeding,severe pulmonary infection,and cardiovascular and cerebrovascular accidents occurred.The control group did not perform preoperative localization of 30 patients.Firstly,the location of the nodule was judged according to CT,the instrument was used to probe or finger touch nodules,and then wedge resection was performed.From the time of insertion of the thoracoscope into the specimen removal,the average time was 29.1 ± 7.9min.There were 3 cases of thoracotomy due to the inability to detect the nodal location,and 5 cases of direct lobectomy due to no obvious nodule after wedge resection.Conclusion:CT-guided localization of small pulmonary nodules with methylene blue medical glue or autologous blood is safe,simple and accuracy.It is a feasible technique for small pulmonary nodules localization.Objective: One of the most difficult aspects of thoracoscopic enucleation is the precise localization of small tumors(?1.5 cm).We developed a novel methylene blue staining technique to localize small esophageal leiomyomas and evaluated the feasibility.Methods:Between January 2013 and October 2016,9 patients with small esophageal leiomyomas(?1.5 cm)underwent thoracoscopic enucleation.We preoperatively injected 0.5–1.0 m L methylene blue in the submucosa adjacent to the tumors under standard gastroscope guidance.Then,we transferred the patients to the operating room.Results: Staining was successful in 9 patients.The unstained tumor was exposed after the blue-stained mediastinal pleura and overlying muscle were incised longitudinally during Video-assisted Thoracoscopic Surgery.No abnormalities were detected in the esophageal mucosa.No major complications,such as esophageal leakage or esophageal diverticulum,occurred.Conclusion: Endoscopic methylene blue staining is safe and feasible for localizing small esophageal leiomyomas during two-port Video-assisted Thoracoscopic Surgery.This method will enable precise and easy enucleation.