Abstract
ObjectivesVideo assisted thoracoscopic surgery (VATS) can currently be used to diagnose and treat pulmonary nodules. However, intraoperative location of pulmonary nodules in VATS is challenging due to their small diameter and deep location in the pulmonary parenchyma. The purpose of this study was to report the clinical safety and effectiveness of CT-guided hook-wire for preoperative localization of malignant pulmonary nodules smaller than 1 cm in diameter.MethodsFrom February 2017 to January 2018, we collected the data of 80 patients with malignant pulmonary nodules less than 1 cm in diameter who underwent CT-guided hook-wire preoperative localization and VATS surgery. The effectiveness of preoperative localization was evaluated based on surgical duration, success rate of VATS surgery, and localization-related complications.ResultsThe diameter of pulmonary nodules were 0.85 ± 0.17 mm with a distance to the pleural surface of 19.66 ± 14.10 mm. The length of the hook-wire in the lung parenchyma was 29.17 ± 13.14 mm and hook-wire dislodgement occurred in 2 patients. Complications included 27 cases of minor pneumothorax and 18 cases of mild parenchymal hemorrhage. A significant correlation was observed between the length of the hook-wire in the lung parenchyma and mild parenchymal hemorrhage (P = 0.044). The average time of hook-wire localization was 9.0 ± 2.6 min and the average operation time for VATS was 89.02 ± 23.35 min without conversion thoracotomy.ConclusionsCT-guided hook-wire localization of the lesion during VATS resection is safe for malignant pulmonary nodules with diameter less than 1 cm.
Highlights
Low-dose spiral computed tomography (CT) screening for early lung cancer is a promising strategy for improving lung cancer survival and can reduce lung cancer
video assisted thoracoscopic surgery (VATS) is widely used for the treatment of pulmonary nodules and provides less discomfort and reduced postoperative complications compared to standard thoracotomy [3, 4]
Most pulmonary nodules are inaccessible by finger palpation during VATS, which may lead to an increase in thoracotomy up to 46% [5, 6]
Summary
Low-dose spiral computed tomography (CT) screening for early lung cancer is a promising strategy for improving lung cancer survival and can reduce lung cancerZhang et al Journal of Cardiothoracic Surgery (2020) 15:307 available for accurate diagnosis, resection of the pulmonary nodule with video assisted thoracoscopic surgery (VATS) is often recommended for definitive diagnosis and treatment. VATS is widely used for the treatment of pulmonary nodules and provides less discomfort and reduced postoperative complications compared to standard thoracotomy [3, 4]. Most pulmonary nodules (especially with GGO) are inaccessible by finger palpation during VATS, which may lead to an increase in thoracotomy up to 46% [5, 6]. The localization of pulmonary nodules during VATS is an important ongoing issue. Several techniques exist for pulmonary nodule localization including finger palpation [7], intraoperative ultrasound [8], hook-wire [9], micro-coil [10], and methylene blue [11]. We report the safety and effectiveness of preoperative CT-guided hook-wire for the localization of malignant pulmonary nodules smaller than 1 cm in diameter
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