Pediatric Radiology

, Volume 43, Issue 9, pp 1144–1151 | Cite as

Lung tattooing combined with immediate video-assisted thoracoscopic resection (IVATR) as a single procedure in a hybrid room: our institutional experience in a pediatric population

  • Surendra NarayanamEmail author
  • Ted Gerstle
  • Joao Amaral
  • Philip John
  • Dimitri Parra
  • Michael Temple
  • Bairbre Connolly
Original Article



Analysis of small pulmonary nodules in children poses an important diagnostic and therapeutic challenge for clinicians.


To review our experience of lung tattooing with immediate video-assisted thoracoscopic resection (IVATR) performed as a single procedure in a hybrid room for technical difficulties, complications and diagnostic yield of the procedure.

Material and methods

Retrospective analysis of 31 children (16 boys, 15 girls) who underwent lung tattooing of various lesions from January 2001 to July 2011. Data were collected from the Interventional Radiology database, Electronic Patient Chart (EPC) and PACS.


A total of 34 lesions were treated in 31 children. Tattooing was performed on lung lesions with median size 3 mm and median depth 2 mm from pleura. Technical success was 91.1% and diagnostic yield was 100%. In seven children, it was combined with other interventional radiologic procedures. The median procedure time for lung tattooing and IVATR was 197 min.


Lung tattooing with IVATR as a single procedure in a hybrid room is safe and effective in children with several inherent advantages, including avoiding the need to move the child from the interventional radiology suite to the operating room.


Tattooing Lung Methylene blue Hybrid room CT Ultrasound Children 



We thank Dr. Derek Armstrong who supplied the schematic diagram for Fig. 5.

Conflicts of interest



  1. 1.
    Hau T, Förster E, Gandawidjaja L et al (1996) Thoracoscopic pulmonary surgery: indications and results. Eur J Surg 162:23–28PubMedGoogle Scholar
  2. 2.
    McConnell PI, Feola GP, Meyers RL (2002) Methylene blue-stained autologous blood for needle localization and thoracoscopic resection of deep pulmonary nodules. J Pediatr Surg 37:1729–1731PubMedCrossRefGoogle Scholar
  3. 3.
    Magistrelli P, D’Ambra L, Berti S et al (2009) Use of India ink during preoperative computed tomography localization of small peripheral undiagnosed pulmonary nodules for thoracoscopic resection. World J Surg 33:1421–1424PubMedCrossRefGoogle Scholar
  4. 4.
    Kawanaka K, Nomori H, Mori T et al (2009) Marking of small pulmonary nodules before thoracoscopic resection: injection of lipiodol under CT-fluoroscopic guidance. Acad Radiol 16:39–45PubMedCrossRefGoogle Scholar
  5. 5.
    Chen S, Zhou J, Zhang J (2011) Video-assisted thoracoscopic solitary pulmonary nodule resection after CT-guided hookwire localization: 43 cases report and literature review. Surg Endosc 25:1723–1729PubMedCrossRefGoogle Scholar
  6. 6.
    Powell TI, Jangra D, Clifton JC et al (2004) Peripheral lung nodules: fluoroscopically guided video-assisted thoracoscopic resection after computed tomography-guided localization using platinum microcoils. Ann Surg 240:481–488PubMedCrossRefGoogle Scholar
  7. 7.
    Kang DY, Kim HK, Kim YK (2011) Needlescopy-assisted resection of pulmonary nodule after dual localisation. Eur Respir J 37:13–17PubMedCrossRefGoogle Scholar
  8. 8.
    Partrick DA, Bensard DD, Teitelbaum DH et al (2002) Successful thoracoscopic lung biopsy in children utilizing preoperative CT-guided localization. J Pediatr Surg 37:970–973PubMedCrossRefGoogle Scholar
  9. 9.
    Gow KW, Saad DF, Koontz C et al (2008) Minimally invasive thoracoscopic ultrasound for localization of pulmonary nodules in children. J Pediatr Surg 43:2315–2322PubMedCrossRefGoogle Scholar
  10. 10.
    Yoshida J, Nagai K, Nishimura M et al (1999) Computed tomography-fluoroscopy guided injection of cyanoacrylate to mark a pulmonary nodule for thoracoscopic resection. Jpn J Thorac Cardiovasc Surg 47:210–213PubMedCrossRefGoogle Scholar
  11. 11.
    McCormack PM, Ginsberg KB, Bains MS et al (1993) Accuracy of lung imaging in metastases with implications for the role of thoracoscopy. Ann Thorac Surg 56:863–865PubMedCrossRefGoogle Scholar
  12. 12.
    Waldhausen JH, Shaw DW, Hall DG et al (1997) Needle localization for thoracoscopic resection of small pulmonary nodules in children. J Pediatr Surg 32:1624–1625PubMedCrossRefGoogle Scholar
  13. 13.
    Lenglinger FX, Schwarz CD, Artmann W (1994) Localization of pulmonary nodules before thoracoscopic surgery: value of percutaneous staining with methylene blue. AJR Am J Roentgenol 163:297–300PubMedCrossRefGoogle Scholar
  14. 14.
    Jiménez MF, Spanish Video-Assisted Thoracic Surgery Study Group (2001) Prospective study on video-assisted thoracoscopic surgery in the resection of pulmonary nodules: 209 cases from the Spanish Video-Assisted Thoracic Surgery Study Group. Eur J Cardiothorac Surg 19:562–565PubMedCrossRefGoogle Scholar
  15. 15.
    Vandoni RE, Cuttat JF, Wicky S et al (1998) CT-guided methylene-blue labelling before thoracoscopic resection of pulmonary nodules. Eur J Cardiothorac Surg 14:265–270PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Surendra Narayanam
    • 1
    Email author
  • Ted Gerstle
    • 2
  • Joao Amaral
    • 1
  • Philip John
    • 1
  • Dimitri Parra
    • 1
  • Michael Temple
    • 1
  • Bairbre Connolly
    • 1
  1. 1.Department of Diagnostic Imaging, Division of Image Guided TherapyThe Hospital for Sick ChildrenTorontoCanada
  2. 2.Division of General and Thoracic SurgeryThe Hospital for Sick ChildrenTorontoCanada

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