A barium marking method using an ultrathin bronchoscope with virtual bronchoscopic navigation

CT scanning in a 77-year-old woman showed a ground-glass opacity pattern shadow (9 x 7 mm) in the right lower lobe. To allow identification of the location of the lesion during thoracoscopic surgery, preoperative barium marking was performed using an ultrathin bronchoscope and virtual bronchoscopic navigation. Virtual bronchoscopy was performed based on thin-section CT images, and virtual bronchoscopic images to the target sites were obtained. Subsequently, using virtual bronchoscopic images to right B(8)aiibetax, B(6)biibeta for navigation, an ultrathin bronchoscope was advanced to this site under direct observation. A special catheter for ultrathin bronchoscopy was advanced to sites near the lesion, and barium was infused. Barium was clearly observed by radiographic fluoroscopy during thoracoscopic surgery and was useful for determining the area for resection. Pathological examination of the resected specimen revealed atypical adenomatous hyperplasia. There were no complications with this method, and a number of target areas could be readily marked in a short time. This method may be useful before thoracoscopic surgery for small peripheral pulmonary lesions.