What are the lungs?
The lungs are a pair of elastic, air-filled organs. They are used for breathing, which involves the exchange of oxygen and carbon dioxide. They expand and contract in size every time your child breathes in and out. They are located on either side of the chest.
What is lung tattooing with IVATR?
Lung tattooing with IVATR (immediate video-assisted thoracoscopic resection) involves injecting dye into the specific location in the lung that your child’s health-care provider is interested in viewing. The dye will stain the area of interest (the lung lesion) and make it easier to see. This allows for a more accurate identification of the lesion location so that it can be removed or biopsied by a surgeon.
Why is lung tattooing with IVATR performed?
A child may have lung tattooing with IVATR if they are not a suitable candidate for an image-guided lung biopsy, or if they require a total resection (cutting out) of the lung lesion.
A child may not be a suitable candidate for a lung biopsy by image guidance if the lung lesion is:
- very small
- not in an accessible location
- not visible using ultrasound
How is lung tattooing with IVATR performed?
Lung tattooing is performed by an interventional radiologist using image guidance. The lung lesion is then resected (cut out) or biopsied by a surgeon.
During the procedure, a small needle is inserted into the area of the lung that the surgeon needs to resect or biopsy. The interventional radiologist uses a CT scan to guide the needle to the correct location. A small amount of dye is then injected into the lung lesion. The stained or tattooed area will appear as a blue spot against the pink inflated lung during surgery. The surgeon then resects a sample of the lung lesion or completely removes it. The piece of lung that is resected is sent to the laboratory for examination. After the lesion has been resected, the surgeon may place a small chest tube in your child to drain out any blood or air.
Lung tattooing with IVATR usually takes two to three hours.
Risks of lung tattooing with IVATR
Lung tattooing with IVATR is usually a low-risk procedure. The risk may increase depending on your child’s condition, age and health.
If bleeding or air leakage occurs, your child may require a small chest tube to drain out the blood or air.
Preparing for lung tattooing with IVATR
Visiting the interventional radiologist before the procedure
Your child will meet with the interventional radiologist before the procedure. During the visit, you should expect the following:
- A health assessment to make sure your child is healthy and that it is safe for them to have general anesthesia.
- An overview of the procedure, and a review of the consent form.
- Blood work to be taken, if needed.
Giving consent before the procedure
Before the procedure, the interventional radiologist will go over how and why the procedure is done, as well as the potential benefits and risks. They will also discuss what will be done to reduce these risks and will help you weigh the benefits against them. It is important that you understand all these potential risks and benefits of the lung tattooing with IVATR and that all your questions are answered. If you agree to the procedure, you can give consent for treatment by signing the consent form. A parent or legal guardian must sign the consent form for young children. The procedure will not be done unless you give your consent.
How to prepare your child for the procedure
Before any treatment, it is important to talk to your child about what will happen. When talking to your child, use words they can understand. Let your child know that medicines will be given to make them feel comfortable during the procedure.
Children feel less anxious and scared when they know what to expect. Children also feel less worried when they see their parents are calm and supportive.
If your child becomes ill within two days before the procedure
It is important that your child is healthy on the day of the procedure. If your child starts to feel unwell or has a fever within two days before the lung tattooing, let their health-care provider know. Your child’s procedure may need to be rescheduled.
Food, drink, and medicines before the procedure
- Your child’s stomach must be empty before and during sedation or general anesthetic.
- If your child has special needs during fasting, talk to their health-care provider to make a plan.
- Your child can take their regular morning medicine with a sip of water two hours before the procedure.
- Medicines such as acetylsalicylic acid (ASA), naproxen or ibuprofen, warfarin, or enoxaparin may increase the risk of bleeding. Do not give these to your child before the procedure unless they have been cleared first by their health-care provider and the interventional radiologist.
On the day of the lung tattooing with IVATR
Arrive at the hospital two hours before the planned time of your child’s procedure. Once you are checked in, your child will need to change into a hospital gown and be weighed and assessed. You will also be given an opportunity to speak to the interventional radiologist, the surgeon and the anesthesiologist at this time. The interventional radiologist will be performing the lung tattooing with IVATR; the surgeon will be resecting the lesion, and the anesthesiologist will be giving your child medication to make them comfortable for the procedure.
During the lung tattooing, you will be asked to wait in the waiting area.
Your child will have medicine for pain
It is important that your child is as comfortable as possible for the procedure. Your child will receive a general anesthetic for the lung tattooing procedure, so they will not hear or feel anything during the procedure.
After the lung tattooing with IVATR
Once the lung tattooing with IVATR is complete, your child will be moved to the recovery area. The interventional radiologist and surgeon will come and talk to you about the details of the procedure. As soon as your child starts to wake up, a nurse will come get you. Your child will be monitored in a surgical ward and will be ready to go home once appropriate.
Your child will have a dressing on the procedural site. One to two hours after the procedure, your child will have a chest X-ray to look for any bleeding or air leakage. Your child may require a chest tube if there is any blood or air leakage.
A blood test may also be taken after the procedure to identify any changes in blood levels. If your child’s hemoglobin drops, an ultrasound may be ordered.
The length of hospital stay will depend on your child's overall health. In most cases, children go home only after the chest tube is removed (if inserted) and once appropriate for discharge. Your child’s health-care provider will let you know when your child is well enough to go home.
At SickKids
At SickKids, the interventional radiologists work in the Department of Diagnostic Imaging - Division of Image Guided Therapy (IGT).
For more information on preparing your child for their procedure, see Coming for surgery.