Video-assisted thoracoscopic resection of pulmonary nodules: Preoperative localization with India ink

Video-assisted thoracoscopic surgery (VATS) has been used increasingly for the biopsy of pulmonary nodules. In cases where the nodule is small or intrapulmonary, thoracoscopic visualization may be difficult. A technique for preoperative localization of such nodules using India ink is described. Two children with suspected lung metastases had small, subpleural nodules, which were not expected to be easily visualized thoracoscopically. Under guidance by computed tomography, both underwent subpleural injection of India ink, followed by excision of the lesion using VATS. In both cases the tattoo was easily seen at the time of surgery, the nodule was found in the resected specimen, and a diagnosis was made. Both patients experienced mild pleuritic pain and a small pneumothorax, which did not require tube thoracostomy. Preoperative localization using India ink is an effective, safe technique for identification of small or intrapulmonary nodules and is a useful adjunct to VATS.