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Video-assisted thoracic surgery (VATS) is increasingly being performed for partial lobectomy for pulmonary nodules because it is less invasive than thoracotomy and offers the possibility of therapeutic diagnosis. However, because small or ground-grass opacity nodules are difficult to detect on thoracoscopy, localization is required prior to VATS.
Recent studies have reported the effectiveness of lung nodule localization using a mixture of dye material and contrast medium. Use of high viscosity materials might prevent migration and ischemic complications. The injection point of the material can be detected on thoracoscopy by dye pigmentation on the lung surface. In the event that the pigmentation is unclear, the injection point can be confirmed using intraoperative fluoroscopy because the mixture is radiopaque. However, the optimal combination of dye and contrast medium for this technique is unknown.