CT-guided hook-wire localization of malignant pulmonary nodules for video assisted thoracoscopic surgery

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 1cm in diameter.MethodsFrom February 2017 to January 2018, we collected the data of 80 patients with malignant pulmonary nodules less than 1cm 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 0.850.17mm with a distance to the pleural surface of 19.66 +/- 14.10mm. The length of the hook-wire in the lung parenchyma was 29.17 +/- 13.14mm 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 +/- 2.6min and the average operation time for VATS was 89.02 +/- 23.35min without conversion thoracotomy.Conclusions CT-guided hook-wire localization of the lesion during VATS resection is safe for malignant pulmonary nodules with diameter less than 1cm.