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

Abstract

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 ...

Implementation of sodium alginate-Fe3O4 to localize undiagnosed small pulmonary nodules for surgical management in a preclinical rabbit model

“…Our in vitro experiments proved that the sodium alginate magnetic fluid immediately formed a gel after contact with the curing agent. The maximum magnetic force between the magnetic gel and the pursuit magnet was 0.22 N, which is similar to the maximum anchoring force of the traditional micro-coil method reported in the literature (0.20 N) 38 . The force was sufficient to make a tuberous part protrude from the lung surface without causing the magnetic gel to fall away.…”

Computed tomography-guided preoperative semi-rigid hook-wire localization of small pulmonary nodules: 74 cases report

“…Ultrasonography offers a quick, affordable, less invasive way of localizing lesions but is limited by the presence of air in the lungs [12]. Based on the mentioned above, we compared the advantages and disadvantages between single semi-rigid hook wire, double-thorn hook wire and micro-coil through a swine lung experiment and found that semi-rigid hook wire showed the better operability than the other two, which was already published in December 2017 [13]. In the present study, 74 consecutive patients with 81 pulmonary nodules underwent CT-guided single semi-rigid hook wire localization prior to VATS were examined.…”

“…We previously conducted a localization experiment in the swine lung and reported that among the commonly used three location methods, semi-rigid hook wire showed better operability and practicability than double-thorn hook wire and micro-coil [13]. In the present study, we continued to use the semi-rigid single hook wire localization technique for individuals during VATS resection.…”

Hook Wire Placement Facilitates Laparoscopic Excision of Endophytic Renal Tumor in Partial Nephrectomy

“… 1 Image-guided hook wires, which are now used in surgery, particularly in spinal surgery, thoracoscopic surgery, and breast surgery, allow for the precise localization of tumor sites. 2 , 3 We report the case of a woman undergoing laparoscopic partial nephrectomy in which a hook wire was used. The hook wire facilitated the localization of the lesion and avoided cutting into the lesion directly.…”