Application of computed tomography-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm)

Abstract

Objective This study aimed to investigate the safety and efficacy of the computed tomography (CT)-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm) and to identify the risk factors for localization-related complications. Methods The medical records of 150 patients with small pulmonary nodules treated from January 2018 to June 2021 were retrospectively analyzed. According to preoperative hook-wire positioning status, they were divided into the localization group (50 cases) or the control group (100 cases). The operation time, intraoperative blood loss, hospital stay, and conversion rate to thoracotomy were recorded and compared between groups. Uni- and multivariate binary logistic regression analysis was used to identify the risk factors for localization-related complications. Results A total of 58 nodules were localized in 50 patients in the localization group, and the localization success rate was 98.3% (57/58). In one case, the positioning pin fell off before wedge resection was performed. The mean nodule diameter was 7.05 mm (range, 2.8–10.0 mm), while the mean depth from the pleura was 22.40 mm (range, 5.47–79.47 mm). There were 8 cases (16%) of asymptomatic pneumothorax, 2 (4%) of intrapulmonary hemorrhage, and 1 (2%) of pleural reaction.The mean operation time of the localization group (103.88 ± 41.74 min) was significantly shorter than that of the control group (133.30 ± 45.42 min) (P < 0.05). The mean intraoperative blood loss of the localization group (44.20 ± 34.17 mL) was significantly lower than that of the control group (112.30 ± 219.90 mL) (P < 0.05). The mean hospital stay of the localization group (7.96 ± 2.34 days) was significantly shorter than that of the control group (9.21 ± 3.25 days).Multivariate binary logistic analysis showed that localization times of small pulmonary nodules in the localization group was an independent risk factor for localization-related pneumothorax. Conclusions Our results suggest that the CT-guided hook-wire localization technique is beneficial for localizing small pulmonary nodules. Specifically, it is helpful for the diagnosis and treatment of early lung cancer because it can accurately remove lesions, decrease intraoperative blood loss, shorten operation time and hospitalization stay, and reduce thoracotomy conversion rate. Simultaneous positioning of multiple nodules can easily lead to positioning-related pneumothorax.

Comparison between preoperative hook-wire and liquid material localization for pulmonary nodules: a meta-analysis.

“…Technical success is critical for CT-guided localization, and the causes for technical failure vary based on the type of material used. With HW, the primary cause of failure is dislodgement or migration, whereas with LMs the main issue is diffusion [ 21 , 22 ]. In this meta-analysis, the pooled rate of successful localization was notably higher in the group using LM compared to the group using HW.…”

“…The technical success rate was notably high at 99.8% in the LMG, suggesting that LMs may be more effective than HW in localizing PNs. Factors contributing to HW dislodgement or migration include the incomplete release of the hook and patients’ respiratory movements [ 22 ]. However, the technical failure of LML can be mitigated by controlling the volume of the localization material [ 21 ].…”

Preoperative CT-Guided Coil Localization of Lung Nodule Resection: A Single-Center Experience

“…Alternative techniques for preoperative localization of small peripheral pulmonary nodules have been described, including the use of a hookwire [ 6 , 7 ]. While the hookwire technique has shown high success rates, it is associated with complications such as dislodgement [ 8 ].…”