Purposeful Creation of a Pneumothorax and Chest Tube Placement to Facilitate CT-Guided Coil Localization of Lung Nodules before Video-Assisted Thoracoscopic Surgical Wedge Resection

Abstract

PurposeTo evaluate the feasibility and efficacy of pneumothorax creation and chest tube insertion before computed tomography (CT)–guided coil localization of small peripheral lung nodules for video-assisted thoracoscopic surgical (VATS) wedge resection. Materials and MethodsFrom May 2011 to October 2013, 21 consecutive patients (seven men; mean age, 62 y; range, 42–76 y) scheduled for VATS wedge resection required CT-guided coil localization for small, likely nonpalpable peripheral lung lesions at a single institution. Outcomes were evaluated retrospectively for technical success and complications. ResultsThere were 12 nodules and nine ground-glass opacities. Mean lesion distance from the pleural surface was 15 mm (range, 5–35 mm), and average size was 13 mm (range, 7–30 mm). A pneumothorax was successfully created in all patients with a Veress needle, and a chest tube was inserted. All target lesions were marked successfully, leaving one end of the coil within/beyond the lesion and the other end of the coil in the pleural space. The inserted chest tube was used to insufflate air to widen the pleural space during coil positioning and to aspirate any residual air before transfer of the patient to the operating room holding area. Intraparenchymal hemorrhages smaller than 7 cm in diameter developed in two patients during coil placement. All lesions were successfully resected with VATS. Histologic examinaiton revealed 13 primary adenocarcinomas, four metastases, and four benign lesions. ConclusionsPneumothorax creation and chest tube placement before CT-guided coil localization of peripheral lung nodules for VATS wedge resection facilitates the deployment of the peripheral end of the coil in the pleural space and provides effective management of procedure-related pneumothorax until surgery.