Video-assisted thoracoscopic surgery for pulmonary nodules: rationale for preoperative computed tomography-guided hookwire localization

Ciriaco, Paola; Negri, Giampiero; Puglisi, Armando; Nicoletti, Roberto; Maschio, Alessandro Del; Zannini, Piero

doi:10.1016/j.ejcts.2003.11.036

Cited by 171 publications

(177 citation statements)

References 15 publications

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“…One major problem with hookwires is the rate of dislodgement, as a component of the wire is external to the chest. This complication has been shown at rates ranging from 0-7.5% (22,23). Average length of stay was 3 days for VATS patients (22).…”

Section: Discussionmentioning

confidence: 97%

“…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%

“…This complication has been shown at rates ranging from 0-7.5% (22,23). Average length of stay was 3 days for VATS patients (22). Two commercial hookwire systems have been developed, the first in 1995 by Kanazawa et al This system attempted to improve upon breast localization designs by making the wire 10 mm in length and attaching a 30-cm nylon suture as the component to be brought externally in order to decrease the chance of wire dislodgement secondary to external disruption (25).…”

Section: Discussionmentioning

confidence: 99%

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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: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…With regard to surgery time, we did not make a comparison between localization with and without the CT-guided hookwire system prior to VATS. However, Ciriaco et al (14) reported that hookwire localization made VATS resection quicker, independent of whether it was conducted with preoperative localization or not. In this study, the average surgery time was 40±7 and 75±12 min (P<0.001), and the average time of CT hookwire positioning was 20±10 min.…”

Section: Discussionmentioning

confidence: 99%

Combination of CT-guided hookwire localization and video-assisted thoracoscopic surgery for pulmonary nodular lesions: Analysis of 103 patients

Wang

et al. 2012

Oncology Letters

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Abstract. At present, there is no standardized method for the diagnosis and management of pulmonary nodular lesions (PNLs) smaller than 3 cm. This study investigated the use of computed tomography (CT)-guided hookwire localization and video-assisted thoracoscopic surgery (VATS) for PNLs. A total of 103 patients undergoing CT-guided hookwire localization and VATS were enrolled, and 107 lesions were collected. We assessed the localization achievement ratio, complications rate, conversion thoracotomy rate, intraoperative dislodgement rate, pathological diagnosis rate, duration of surgery and average days of hospitalization. All 107 nodules from 103 patients were successfully localized (100%), the asymptomatic pneumothorax rate was 36.9%, the asymptomatic hemorrhage rate was 40.8% and the simultaneous pneumothorax and hemorrhage rate was 8.7%. A conversion thoracotomy was required in 2 (1.9%) patients and the intraoperative dislodgement rate was 2.9%. The average time for localization was 11±4 min, and the average times for wedge resection and lobectomies were 16±2 and 95±30 min, respectively. The mean hospitalization time following the surgery was 6±3 days. All 107 nodules managed to achieve pathological diagnoses. A combination of CT-guided hookwire localization and VATS for PNL is a safe and efficient procedure of great clinical value.

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“…Ciriaco et al (2) described its use in a series of 53 VATS procedures in 2004, and successful identification rates over 95% can be achieved with this method by several authors in series over 50 cases (3)(4)(5). The potential pitfalls of this technique were the potential side effects of pneumothorax and bleeding, but also migration of the wire, when the lung collapses during surgery.…”

Section: Available Methodsmentioning

confidence: 99%

Location techniques of pulmonary lesions during video-assisted thoracic surgery: a perspective

Martin-Ucar

Socci

2016

J. Vis. Surg.

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We read with interest the article by Bertolaccini et al. describing the use of radioactive injections to identify small solitary pulmonary nodules or impalpable ground glass opacities (GGO) during video-assisted thoracic surgery (VATS) surgery (1). The advocates of localization methods for these lesions have described over the years different techniques in thoracic surgery, most of them derived from their uses in other organs and specialties. Available methodsThe use of CT-guided hooks applying a valid concept used in the diagnosis of small breast lesions diagnosis was probably the initial one. Ciriaco et al. (2) described its use in a series of 53 VATS procedures in 2004, and successful identification rates over 95% can be achieved with this method by several authors in series over 50 cases (3)(4)(5). The potential pitfalls of this technique were the potential side effects of pneumothorax and bleeding, but also migration of the wire, when the lung collapses during surgery. It does require collaboration with the Radiology Unit and the patient to be transferred into the operating theatre straight from the Scanner suite. These two areas vary from unit to unit hence the process might not be universally reproducible.To minimize the potential for migration of the wire clinicians developed the insertion of metal coils. The metal coils are no longer attached to the chest wall reducing the potential for migration at lung collapse but also requiring less care to avoid touching or manipulating the wire during Once again the arrangements with the Radiology Unit and the transfer into the operating room are required, but in addition the operating room must be suitable for on the table radiology in order to identify the metal coil.Non-metal markers have been described for identification of lesions during VATS surgery. In 1994 Lenglinger et al. reported the use of methylene blue helping identification in 14 out of 15 patients (7), results mimicked by Vandoni et al. in 2002 in series of 54 patients with a success of 93% (8). The benefit proposed was the safety of avoiding deployment of wires, and not requiring any special radiological equipment in the operating room. However, during VATS the methylene blue mainly directs to the surface point of access and dispersion of the dye might make difficult exact localizations of the lesions.Injection of radiological contrasts did prove 100% successful in 15 and 10 patients respectively by the groups of Choi in 1998 (9) and Lee in 2012 (10). It does however require the availability of radiological equipment in the operating room in order to locate the lesion marked by contrast.A potential advance was adopted from liver surgery, with the ability to identify nodules via ultrasound probe was initially described by Greenfield et al. in 1997 (11)

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Video-assisted thoracoscopic surgery for pulmonary nodules: rationale for preoperative computed tomography-guided hookwire localization

Cited by 171 publications

References 15 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

Combination of CT-guided hookwire localization and video-assisted thoracoscopic surgery for pulmonary nodular lesions: Analysis of 103 patients

Location techniques of pulmonary lesions during video-assisted thoracic surgery: a perspective

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