• Shun-Mao Yang, Kai-Lun Yu, Kun-Hsien Lin, Yueh-Lun Liu, Shao-En Sun, Ling-Hsuan Meng, and Huan-Jang Ko.
• Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
• Surg Endosc. 2020 Jan 1; 34 (1): 477-484.

BackgroundSmall pulmonary nodule localization via an endobronchial route is safe and has fewer complications than that with the transthoracic needle approach, but accurate marking without a navigation system remains challenging. We aimed to evaluate the safety and efficacy of endobronchial dye marking using conventional bronchoscopy guided by cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) for small pulmonary nodules.MethodsWe retrospectively reviewed the clinical records of 61 nodules in 51 patients who underwent preoperative CBCT-AF-guided bronchoscopic dye marking, followed by thoracoscopic resection, between July 2018 and March 2019.ResultsThe median nodule size was 8.6 mm [interquartile range (IQR) 7.0-11.8 mm], and the median distance from the pleural space was 15.4 mm (IQR 10.6-23.1 mm). All nodules were identifiable on CBCT images and annotated for AF. The median bronchoscopy duration was 8.0 min (IQR 6.0-11.0 min), and the median fluoroscopy duration was 2.2 min (IQR 1.2-4.0 min). The median radiation exposure (expressed as the dose area product) was 2337.2 µGym2 (IQR 1673.8-4468.8 µGym2). All nodules were successfully marked and resected, and the median duration from localization to surgery was 16.4 h (IQR 4.2-20.7 h). There were no localization-related complications or operative mortality, and the median length of the postoperative stay was 4 days (IQR 3-4 days).ConclusionsBronchoscopic dye marking under CBCT-AF guidance before thoracoscopic surgery was safely conducted with satisfactory outcomes in our initial experience.

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