Preoperative localization of indeterminate pulmonary nodules before videothoracoscopic resection

Paci, Massimiliano; Annessi, Valerio; Giovanardi, Francesco; Ferrari, Guglielmo; Franco, Salvatore De; Casali, Christian; Sgarbi, Giorgio

doi:10.1007/s00464-001-9014-9

Cited by 23 publications

(16 citation statements)

References 8 publications

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“…Their experience with 21 patients resulted in one failed placement with minimal complications and a mean length of stay of 1 to 6 days (21). The technique of using a breast localization wire has been used in a number of other studies, with rates of successful thoracoscopic resection ranging from 80-100% (22)(23)(24). Complication rates ranged from 7.5-51%, and included mostly asymptomatic pneumothoraces (22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature

et al. 2016

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Background: Video-assisted thoracoscopic surgery (VATS) is standard of care for small lung resections at many centres. Computed tomography (CT)-guided insertion of microcoils can aid surgeons in performing VATS resections for non-palpable lung nodules deep to the lung surface.Methods: Retrospective analysis of CT-guided microcoil insertions prior to VATS lung resection at a single institution from October 2008 to January 2014.Results: A total of 63 patients were included (37% male, mean age 61.6±11.4 years). Forty-two patients (67%) had a history of smoking, with 10 current smokers. Sixty one (97%) patients underwent wedge resection and 3 (5%) patients had segmentectomy. Three (5%) patients required intra-operative staple line re-resection for positive or close margins. Eleven (17%) patients had a completion lobectomy, 5 of which were during the same anaesthetic. The average time between the CT-guided insertion and start of operation was 136.6±89.0 min, and average operative time was 84.0±53.3 min. The intra-operative complication rate was 5% (n=3), including 1 episode of hemoptysis, and 2 conversions to thoracotomy. The post-operative complication rate was 8% (5 patients), and included 2 air leaks, 1 hemothorax (drop in hemoglobin), 1 post chest tube removal pneumothorax, and one venous infarction of the lingula after lingula-sparing lobectomy requiring completion lobectomy. . Average post-operative length of stay was 2.2 days. A diagnosis was made for all patients.Conclusions: CT-guided microcoil insertion followed by VATS lobectomy is safe, with short operative times, short length of stay and 100% diagnosis of small pulmonary nodules. This technique will become more important in the future with increasing numbers of small nodules detected on CT as part of lung cancer screening programs.

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Section: Discussionmentioning

confidence: 99%

CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature

et al. 2016

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“…CT-guided marking of lung nodule using hook-wire or microcoil has been repeatedly reported in the literature and proved to be practicable with high sensitivity (3)(4)(5). However, dislodgment of the wires or coils after lung collapses is a frustrating problem and was reported to occur in up to 47% of cases who underwent the hookwire marking procedure (17), which remarkably dampens the outcome of marking.…”

Section: Discussionmentioning

confidence: 99%

“…Among them, CT-guided hookwire or microcoil techniques are preferable due to higher sensitivity, less operator dependence and lower complication rate (3)(4)(5). Nevertheless, dislodgment of the wire or coil after the lung collapses in the surgery remains a disturbing problem and leads to a relatively higher failure rate of marking (6).…”

Section: Introductionmentioning

confidence: 99%

A novel hybrid technique for localization of subcentimeter lung nodules

Pang

Chen

et al. 2017

J. Thorac. Dis.

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Background: It is technically challenging to locate non-visible, non-palpable subcentimeter ground-glass nodules (GGNs) of lung during video-assisted thoracic surgery (VATS). Computed tomography (CT)-guided marking of small pulmonary nodules using microcoils has been reported to be a practical method of preoperative localization, whereas dislodgement of microcoils remains to be a bothersome complication. The objective of this study was to assess the viability and effectiveness of a newly developed hybrid technique, which combines induced controllable pneumothorax and CT-guided microcoil marking procedure to reduce the risk of microcoil dislodgement.Methods: After induced minor pneumothorax, 35 patients with subcentimeter GGNs underwent CTguided marking with microcoils prior to VATS sublobar resection or lobectomy. Histopathological analysis was performed after surgeries.Results: All of 37 nodules were successfully marked before VATS. Segmentectomy was performed in 8 cases, wedge resection in 19 cases and lobectomy in 8 cases. All nodules were completely removed with marking microcoils. Dislodgement of microcoils was not observed in all cases and mild pulmonary hemorrhage occurred in one case. No other complications occurred. Conclusions:The newly developed hybrid technique which combines induced controllable pneumothorax and CT-guided marking using microcoils was feasible and reliable for VATS resection of subcentimeter GGNs, meanwhile significantly lowered the risk of microcoil dislocation.Keywords: Video-assisted thoracoscopic surgery; lung nodule; localization; computed tomography (CT); J Thorac Dis 2017;9(4):1107-1112 jtd.amegroups.com established, such as hook-wire or microcoil labelling, intraoperative ultrasound scan, methylene blue staining and radio-guided detection. Among them, CT-guided hookwire or microcoil techniques are preferable due to higher sensitivity, less operator dependence and lower complication rate (3-5). Nevertheless, dislodgment of the wire or coil after the lung collapses in the surgery remains a disturbing problem and leads to a relatively higher failure rate of marking (6). In the current study, we developed a novel hybrid technique, which combines induced controllable pneumothorax and CT-guided microcoil marking, to reduce or even eliminate the risk of dislodgment. MethodsBetween May 2015 and March 2016, 35 patients with 37 subcentimeter lung GGNs who underwent preoperative CT-guided microcoil marking and VATS resections at our institution were retrospectively reviewed. Only subpleural lesions, presumed impalpable, with a maximum distance to the pleural surface of 30mm were included. Lesions were incidentally found in 33 patients while they underwent health examination or were being examined for other medical reasons. In 2 patients with a clinical history of malignancy, the lesions were found during follow-up examination. No preoperative pathologic diagnoses were obtained, either by fiberoptic bronchoscopy (FOB) or by CT-guided needle lung biopsies. Preoperative marking procedureT ...

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“…Several methods of localization have been reported for resecting small nodules under thoracoscopy. One of the important limitations of thoracoscopic resection of lung nodules is localization of the target, especially when the lesion is very small 11–13 …”

Section: Discussionmentioning

confidence: 99%

“…One of the important limitations of thoracoscopic resection of lung nodules is localization of the target, especially when the lesion is very small. [11][12][13] Based on our experience, we suggest that some techniques may be used to locate small pulmonary nodules. Preoperative localization of small nodules that may not be visible or palpable during VATS is desirable and CT-guided methylene blue localization may be used preoperatively.…”

Section: Discussionmentioning

confidence: 99%

Localization of Small Pulmonary Nodules for Videothoracoscopic Surgery

Zhang

Sun

2006

ANZ Journal of Surgery

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The aim of this study is to discuss and summarize the localization of small pulmonary nodules for video-thoracoscopic surgery. Thirty-eight patients were selected, 22 men and 16 women, and they underwent video-assisted thoracoscopic surgery resection for small pulmonary nodules: 28 patients for small solitary pulmonary nodules and 10 patients for multiple small pulmonary nodules. In all cases, resection of the nodules was successful. Localization methods included: (i) computed tomography (CT)-guided methylene blue labelling for preoperative localization; (ii) a high-quality chest CT scan for preoperative localization; (iii) visual exploration, digital palpation and 'instrumental' palpation to locate the nodule; and (iv) endosonographic inspections of intraoperative localization. Using a combination of CT scan, digital palpation, methylene blue labelling and endosonographic inspections, all nodules were successfully localized and resected without significant complications. Video-assisted thoracoscopic surgery is an effective approach but the small lung nodules (especially those less than 1.0 cm in diameter) localized at thoracoscopic resection must be treated carefully. Combined imaging and thoracoscopic techniques may help identify small nodules.

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Preoperative localization of indeterminate pulmonary nodules before videothoracoscopic resection

Abstract: Preoperative computed tomography hook-wire localization is a suitable strategy for peripheral nodules < or = 1 cm in diameter.

Cited by 23 publications

References 8 publications

CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature

CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature

A novel hybrid technique for localization of subcentimeter lung nodules

Localization of Small Pulmonary Nodules for Videothoracoscopic Surgery

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