Seeds of Gold. Triple Contrast Marking in Hybrid Operative Room for All-in One Diagnostic and Therapeutic Precision Surgery

The minimally invasive management of small lung lesions represents a quite challenging task for thoracic surgeons. As a matter of fact, video-assisted thoracic surgery (VATS) wedge resection could usually require conversion to thoracotomy when pulmonary lesions cannot be identified. Hybrid operating rooms (H-OR) can serve as a helpful tool in providing real-time lesion imaging and targeting, allowing the preoperative placement of different marking techniques to help locate non-palpable nodules. Our aim is to assess the efficacy of our triple contrast technique based on the simultaneous use of three different marking systems, including gold seed Biomarc - Vigeo S.r.l.), methylene blue (Methylthioninium Chloride - Bioindustria L.I.M.), and indocyanine green (-ICG- Verdye - Diagnostic Green Gmbh) to help locate non-palpable lung lesion.