Preoperative Localization of Small Pulmonary Lesions with a Short Hook Wire and Suture System: Experience with 168 Procedures

Dendo, Shuichi; Kanazawa, Susumu; Ando, Akio; Hyodo, Tsuyoshi; Kouno, Yoshihiro; Yasui, Kotaro; Mimura, Hidefumi; Akaki, Shiro; Kuroda, Masahiro; Shimizu, Nobuyoshi; Hiraki, Yoshio

doi:10.1148/radiol.2252011025

Cited by 173 publications

(144 citation statements)

References 25 publications

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“…Studies have showed that pneumothorax and pulmonary hemorrhage, with an incidence of 32.1-68% and 10.3-36%, respectively, in preoperative hook wire placement (22,29,30). Ichinose and colleagues represented similar result, of 500 lesions underwent CT-guided localization, pneumothorax was observed in 49% of the patients immediately after location, only 4.6% require intervention (22), much higher than other study (apply double-thorn hook wire) reported (18.6% and 24.4%) (23).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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Background: The aim of this study was to compare the effects of currently available preoperative localization methods, including semi-rigid single hook-wire, double-thorn hook-wire, and microcoil, in localizing the pulmonary nodules, thus to select the best technology to assist video-assisted thoracoscopic surgery (VATS) for small ground glass opacities (GGO).Methods: Preoperative CT-guided localizing techniques including semi-rigid single hook-wire, doublethorn hook-wire and microcoil were used in re-aerated fresh swine lung for location experiments. The advantages and drawbacks of the three positioning technologies were compared, and then the most optimal technique was used in patients with GGO. Technical success and post-operative complications were used as primary endpoints.Results: All three localizing techniques were successfully performed in the re-aerated fresh swine lung.The median tractive force of semi-rigid single hook wire, double-thorn hook wire and microcoil were 6.5, 4.85 and 0.2 N, which measured by a spring dynamometer. The wound sizes in the superficial pleura, caused by unplugging the needles, were 2 mm in double-thorn hook wire, 1 mm in semi-rigid single hook and 1 mm in microcoil, respectively. In patients with GGOs, the semi-rigid hook wires localizations were successfully performed, without any complication that need to be intervened. Dislodgement was reported in one patient before VATS. No major complications related to the preoperative hook wire localization and VATS were observed. Conclusions:We found from our localization experiments in the swine lung that, among the commonly used three localization methods, semi-rigid hook wire showed the best operability and practicability than doublethorn hook wire and microcoil. Preoperative localization of small pulmonary nodules with single semi-rigid hook wire system shows a high success rate, acceptable utility and especially low dislodgement in VATS. IntroductionThe widespread application of low-dose computed tomography (LDCT) has led to a great increase in the identification rate of small pulmonary nodules, especially small ground glass opacities (GGO). GGO is defined as a hazy opacity that does not obscure underlying bronchial structures or pulmonary vessels on CT scans (1). It has been reported that 33-60% GGO was malignant carcinoma when the nodules size ranges from 11-20 mm, while the malignant rate increase to 64-82% when the size grows up greater than 20 mm (2). Although the identification of pulmonary nodules could be effectively accomplished by many imaging modalities, including high-resolution CT, positron emission tomography (PET/CT), and bronchoscopy, whereas the identification of lesions with GGO remains difficult. Thus, more reliable diagnosis and therapeutic options for uncertain pulmonary nodules are still in need (3).Video-assisted thoracoscopic surgery (VATS) is less invasive in diagnosing and treating thoracic lesions, thus how to locate and mark the nodules more precisely before the VATS becomes one of the most important ...

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Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…The same group published their results in 2002 for 168 patients, with a success rate of 97.6% (4 dislodgements). Procedure time was reported as 25-28 min, and although most patients [110] went to the OR within 1 h, 38 patients waited from 4-14 h between the hookwire insertion and resection (26). Using this system, Miyoshi et al attempted to determine risk factors for dislodgement, but found none that had a significant impact.…”

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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“…of VATS pulmonary resection, and our rate of 98.3% was comparable to that in previous reports. [2][3][4][5] Preoperative lipiodol marking of impalpable pulmonary nodules has several advantages over other marking methods such as metallic coil, [6][7][8][9] hook wire, [10][11][12][13][14] dye, [15][16][17] and barium. [18][19][20] First, it is possible to determine the proper central surgical cut lines because lipiodol can be injected adjacent to targeted lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative localization appears to resolve the former issue, and a number of small nodule localization techniques aimed at guiding VATS resection have been developed. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Although there are many techniques for preoperative localization of pulmonary lesions, CT-guided lipiodol marking may be the most appropriate method for impalpable pulmonary lesions for several reasons. We describe the procedure and assess the usefulness of the CT-guided lipiodol marking technique based on our experiences.…”

Section: Introductionmentioning

confidence: 99%

Video-Assisted Thoracoscopic Surgery after Preoperative CT-Guided Lipiodol Marking of Small or Impalpable Pulmonary Nodules

Mogi

Yajima

Tomizawa

et al. 2015

ATCS

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Purpose: Small pulmonary lesions that include ground-glass attenuation have been increasingly discovered because of progressive imaging diagnostic technologies. Despite the detection of such small lesions, sometimes it is quite difficult to localize them because of their size or considerable depth from the visceral pleura. In the present study, we examined the usefulness of computed tomography-guided lipiodol marking for thoracoscopic resection of impalpable pulmonary nodules. Methods: Fifty-six patients with an undiagnosed peripheral lesion(s) of the lung who had undergone preoperative computed tomography-guided lipiodol marking followed by video-assisted thoracoscopic surgery were studied. Results: All of the nodules were successfully marked by computed tomography-guided lipiodol marking, and all except for one case were localized by means of intraoperative fluoroscopy as clear spots. With regard to complications, pneumothorax occurred in 21 patients (37.5%), and only one patient required transient drainage. Although hemorrhaging in the lung parenchyma and hemosputum occurred in nine patients (16.1%) and one patient (1.8%), respectively, no patients were in serious condition. No intra-or postoperative mortality or morbidity was observed. Conclusion: Preoperative computed tomography-guided lipiodol marking of small or impalpable pulmonary nodules is a safe and useful procedure for thoracoscopic resection of the lung.

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Preoperative Localization of Small Pulmonary Lesions with a Short Hook Wire and Suture System: Experience with 168 Procedures

Abstract: This system with a flexible suture for preoperative localization has a high success rate.

Cited by 173 publications

References 25 publications

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

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

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

Video-Assisted Thoracoscopic Surgery after Preoperative CT-Guided Lipiodol Marking of Small or Impalpable Pulmonary Nodules

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