CT-Guided Hook-Wire Localization of Malignant Pulmonary Nodules for Video Assisted Thoracoscopic Surgery

Abstract

Objectives: Video assisted thoracoscopic surgery (VATS) can currently be used to diagnose and treat pulmonary nodules. However, intraoperative location of pulmonary nodules in VATS is challenging due to their small diameter and deep location in the pulmonary parenchyma. The purpose of this study was to report the clinical safety and effectiveness of CT-guided hook-wire for preoperative localization of malignant pulmonary nodules smaller than 1 cm in diameter.Methods: From February 2017 to January 2018, we collected the data of 80 patients with malignant pulmonary nodules less than 1 cm in diameter who underwent CT-guided hook-wire preoperative localization and VATS surgery. The effectiveness of preoperative localization was evaluated based on surgical duration, success rate of VATS surgery, and localization-related complications.Results: The diameter of pulmonary nodules were 0.85 ± 0.17 mm with a distance to the pleural surface of 19.66 ± 14.10 mm. The length of the hook-wire in the lung parenchyma was 29.17 ± 13.14 mm and hook-wire dislodgement occurred in 2 patients. Complications included 27 cases of minor pneumothorax and 18 cases of mild parenchymal hemorrhage. A significant correlation was observed between the length of the hook-wire in the lung parenchyma and mild parenchymal hemorrhage (P = 0.044). The average time of hook-wire localization was 9.0 ± 2.6 min and the average operation time for VATS was 89.02 ± 23.35 min without conversion thoracotomy.Conclusions: CT-guided hook-wire localization of the lesion during VATS resection is safe for malignant pulmonary nodules with diameter less than 1 cm.

Computed Tomography–Guided Microcoil Localization of Pulmonary Nodules: Effects of Multiple Punctures

“…14 Several other localization methods have also been described. Hook wire localization is an alternative which has been shown to be safe for malignant pulmonary nodules less than 1 cm in diameter, 2 although it has a relatively lower success rate, at operation, because of dislodgement or migration in some series. 9 A study comparing the localization of small lung nodules with microcoil and hook wire showed that microcoil localization had fewer displacements and complications than hook wire localization.…”

“…1 With the widespread use of low-dose computed tomography (CT) in lung cancer screening, increasing numbers of lung nodules are detected, some of which are found to be lung cancer. 2 Video-assisted thoracoscopic surgery (VATS) is a common technique for wedge resection of lung. Unfortunately, some pulmonary nodules cannot be located because they are invisible or inaccessible at thoracoscopic resection due to their small size.…”