Endofinger for tactile localization of pulmonary nodules during thoracoscopic resection.

To localize a deeply situated small pulmonary nodule during thoracoscopic resection, we developed as instrument a so-called "endofinger" for tactile localization of the nodule, and examined its usefulness. An attempt was made in 26 patients, using endofinger palpation under thoracoscopy, to localize twenty-six pulmonary nodules, each of which was less than 20 mm in diameter (mean 12.2 mm) and situated apart from the pleural surface. An endofinger comprises an extended "finger' section connected with a sleeve section. The sleeve section fits with a large contract area over the surgeon's forefinger, effectively lengthening it. The surgeon uses an endofinger in each hand and palpates a pulmonary nodule with the endofinger from two directions simultaneously. Surgeons could feel the hardness of nodules with a high degree of sensitivity. The sense of touch of the endofinger is much better than that of a simple bar, due to the large contact area of the sleeve section with the real finger. With the endofinger palpation 22 of 26 nodules were localized and their margins confirmed. All of 19 nodules larger than 10 mm in size had their locality confirmed by endofinger palpation. Four of 7 nodules smaller than 10 mm in size could not be localized, however. The endofinger is a useful instrument for tactile localization of pulmonary nodules under thoracoscopic surgery, especially for nodules larger than 10 mm. The method is simple, low-cost, time-saving, and has no complications.