Intraoperative CT-guided hook-wire localization to facilitate resection of small solitary pulmonary nodule (SPN) by Video-assisted thoracic surgery (VATS): Experience in 42 consecutive patients

摘要

Background: Video-assisted thoracic surgery (VATS) provides a minimally invasive means to resect pulmonary nodules. However, small solitary pulmonary nodules (SPN) remain problematic during VATS owing to unpredictable visualization and palpation. Intraoperative small SPN localization provides a more obvious target to facilitate intraoperative resection. This study is a single-institution validation of intraoperative CT-guided hook wire localization for small SPN in VATS. Methods: The records of 42 patients with 45 small SPN underwent intraoperative CT-guided doublethorn hook wire localization prior to video-assisted thoracoscopic wedge resection from September 2008 and August 2013 was reviewed retrospectively. All patients received VATS within 10minutes after wire localizations. The efficacy of intraoperative localization was evaluated in terms of procedure time, VATS success rate and associated complications of localization. Results: A total of 42 patients (30 males, 12 females) underwent 45 VATS resections, with simultaneous bilateral nodule resections performed in 3 patients. Nodule diameters ranged from 4 mm to 20 mm (mean, 6.8 mm). The distance of the lung lesions to the nearest pleural surfaces ranged from 2 mm to 30 mm (mean, 12.5 mm). All resections of the lesions (100%). guided by the inserted hook wires were successfully performed by VATS The mean procedure time for CT-guided hook wire localization was 8.4 minutes (range: 6-15 minutes). The mean procedure time for VATS was 52 minutes (range: 14-98 minutes). Pathologic examination revealed 18 primary lung cancers, 21 atypical adenomatous hyperplasia (AAH), 4 metastases, 2 nonspecific chronic inflammation. No major complications related to the intraoperative hook wire localization and VATS were noted. Conclusion: Intraoperative CT-guided hook wire localization is useful, helps in precise small SPN localization in VATS wedge resection, and has a very low rate of minor complications.