CT-Guided Microcoil Localization of Small Peripheral Pulmonary Nodules to Direct Video-Assisted Thoracoscopic Resection without the Aid of Intraoperative Fluoroscopy

Abstract

Objective To evaluate the feasibility, safety, and effectiveness of CT-guided microcoil localization of solitary pulmonary nodules (SPNs) for guiding video-assisted thoracoscopic surgery (VATS). Materials and Methods Between June 2016 and October 2019, 454 consecutive patients with 501 SPNs who received CT-guided microcoil localization before VATS in our institution were enrolled. The diameter of the nodules was 0.93 ± 0.49 cm, and the shortest distance from the nodules to the pleura was 1.41 ± 0.95 cm. The distal end of the microcoil was placed less than 1 cm away from the nodule, and the proximal end was placed outside the visceral pleura. VATS was performed under the guidance of implanted microcoils without the aid of intraoperative fluoroscopy. Results All 501 nodules were marked with microcoils. The time required for microcoil localization was 12.8 ± 5.2 minutes. Microcoil localization-related complications occurred in 179 cases (39.4%). None of the complications required treatment. A total of 463 nodules were successfully resected under the guidance of implanted microcoils. VATS revealed 38 patients with dislocated microcoils, of which 28 underwent wedge resection (21 cases under the guidance of the bleeding points of pleural puncture, 7 cases through palpation), 5 underwent direct lobectomy, and the remaining 5 underwent a conversion to thoracotomy. In 4 cases, a portion of the microcoil remained in the lung parenchyma. Conclusion CT-guided microcoil localization of SPNs is safe and reliable. Marking the nodule and pleura simultaneously with microcoils can effectively guide the resection of SPNs using VATS without the aid of intraoperative fluoroscopy.

Outcomes of CT-Guided Deeper Localization Technique for Superficial Pulmonary Nodules

“…The reported rates of intrapulmonary hemorrhage following microcoil localization range 4.1 to 27.3%. 12,18 In the present study, the incidence of pulmonary hemorrhage in both groups was in line with the current literature. An increase in the distance from the microcoil to the pleura inevitably increases the chance of penetrating the pulmonary vessels, and vascular tears cause more complications of intrapulmonary hemorrhage.…”

“…The localization technique described by Huang et al 12 was used in the conventional localization group. First, the patient was placed on the CT scan bed in a suitable position (prone, supine, or lateral).…”

Single-Stage Pulmonary Resection via a Combination of Single Hookwire Localization and Video-Assisted Thoracoscopic Surgery for Synchronous Multiple Pulmonary Nodules

“…8 Recently, several studies have reported the use of CT-guided hookwire or microcoil for preoperative localization of SMPNs, which showed a good success rate, but had various complication rate, including pneumothorax and pulmonary hemorrhage. [10][11][12][13][14][15][16][17] Therefore, the aim of this study was to retrospectively analyze the incidence and predictors of complications related to hookwire localization both in patients with single and multiple nodules, as well as to evaluate the usefulness of a single-stage surgical method of single hookwire localization combined with VATS in SMPNs.…”

Clinical application of CT-assisted body surface localization combined with intraoperative stereotactic anatomical localization in thoracoscopic lung nodule resection: A single-centre retrospective study

“…Common methods include preoperative CT-guided percutaneous placement of hook wires and microcoils. Nonetheless, these procedures may cause complications such as pneumothorax and active bleeding and increase the risk of displacement [12][13][14][15][16]. Other methods involve CT-guided percutaneous placement of radioactive particles or dyes such as methylene blue, but these also lead to complications and additional challenges [17].…”