In patients undergoing video-assisted thoracoscopic surgery excision, what is the best way to locate a subcentimetre solitary pulmonary nodule in order to achieve successful excision?

Abstract

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In patients undergoing video-assisted thoracoscopic surgery (VATS) excision, what is the best way to locate a subcentimetre solitary pulmonary nodule (PN) in order to achieve successful excision?' Altogether, 107 papers were found using the reported search, of which 19 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. The hook-wire technique showed a varied success rate ranging from 58 to 97.6% and a relatively higher failure rate due to wire dislodgement. The most common complication of this method was pneumothorax. CT-guided spiral-wire localization displayed a success rate of 86% with the added advantage of providing more stability than the hook-wire technique and permitting manipulation. Radio-guided localization techniques and fluoroscopic-aided methods using contrast media displayed consistently high sensitivities with few complications. The radio-guided technique had the benefit of allowing a longer time-period between the staining of the nodule and the operation. Ultrasonography showed sensitivities ranging from 92.6 to 100%; however, it is highly operator-dependent. Finger palpation was shown to achieve suboptimal results and should be avoided. We concluded that radio-guided surgery is a preferable method. It showed high accuracy with minimal complications and operator dependence in detecting subcentimetre PNs when compared with other techniques such as ultrasonography, finger palpation, fluoroscopic, hook-wire, spiral-wire and microcoil localization.

Semi-rigid single hook localization the best method for localizing ground glass opacities during video-assisted thoracoscopic surgery: re-aerated swine lung experimental and primary clinical results

“…There have been several techniques used in locating the lung nodules during the VATS resection already. Methylene blue injection carries the risk of spreading the colorant on the pleural surface and the chest cavity during application, which renders subsequent operation difficult, especially in patients with extensive anthracotic swine mentation (7,19). Finger palpation for millimeter nodules is also difficult depending on the composition of the lesion and the distance from the pleura (7).…”

“…In decades, various techniques, including preoperative localization procedures, intraoperative localization using imaging modalities such as intraoperative ultrasonography, hook-wire, contrast media (5,6), dyes, microcoil, finger palpation, radio-guided, were used to overcome the aforementioned unfavorable factors, and the positive and negative aspects have been described (7). Along with the application of various localization methods and the accumulation of operating experience, numerous of doctors have been gradually recognized that physical methods such as hook wire localization showed excellent superiority (8)(9)(10)(11)(12)(13).…”

“…In addition, this method is also relatively safe, since the operating procedure takes shorter time. For example, pneumothorax, the most common complication, probably occurred due to the long procedure time (14), as well as the dislodgement (7). Preoperative localization of pulmonary nodules using combination of percutaneous CT-guided platinum microcoil insertion and operative fluoroscopic visualization is also a safer and more effective technique that increases the success rate of VATS excision (15)(16)(17).…”

Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer?

“…111 Hook-and-wire techniques had a sensitivity of 58% to 97%, with wire dislodgment being the largest source of failure. Technetium-99 radioguidance and fl uoroscopic guidance with contrast material had high sensitivity with few complications.…”

Pulmonary subsolid nodules: what radiologists need to know about the imaging features and management strategy

“…Several researchers have suggested that CT-guided radioactive dye injection, which uses microspheres of human albumin serum labeled with Technetium-99m (99mTc), is preferable to subcentimeter nodules during VATS because it offers higher sensitivity, minimal operator dependence, minimal complications and a lower risk of failures (58). However, this novel method requires preparation of 99mTc-labeled albumin prior to the procedure and requires a special probe during surgery to convert radioactivity into an audio signal.…”