CT-guided Preoperative Localization of Pulmonary Nodules Using a Glucose Test and Tissue Adhesive

To begin, position the patient in a prone position for nodule identification. Use the biopsy grid and a surgical marker to identify and mark the optimal skin entry point. After disinfecting the operative field with iodophor, apply sterile drapes to the surgical field.

Infiltrate local anesthesia using 2%lidocaine from the skin to the parietal pleura. With a sterile vascular clamp, create a central perforation in a disposable dressing bowl. Invert and position the bowl over the operative site.

Then secure it to the drapes with a vascular clamp. Align the puncture needle through the bowl perforation, so that it lightly contacts the marked entry point. Next, advance the 22 gauge Chiba needle along the planned trajectory.

Shift the entire secured system, including the drapes and bowl, to adjust the needle angle or direction. Perform intermittent CT scans two centimeters from the target after each one to two centimeter advancement. Inject 0.3 milliliters of 5%glucose solution slowly at a rate of 0.05 milliliters per second.

Then inject 0.3 to 0.5 milliliters of alpha cyanoacrylate medical adhesive. After three seconds, withdraw the needle. Perform a confirmatory CT scan immediately after injection.

Verify the presence of a spherical or flake-shaped hyperdense marker adjacent to the nodule. Localization of a peripherally located pulmonary lesion by targeting its medial aspect resulted in close spatial correspondence between the tumor nodule and the deposited medical adhesive. Localization of a peripherally located pulmonary lesion by targeting its lateral aspect demonstrated adhesive deposition adjacent to the tumor margin with clear separation between the tumor tissue.