CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature

Abstract

Background: Video-assisted thoracoscopic surgery (VATS) is standard of care for small lung resections at many centres. Computed tomography (CT)-guided insertion of microcoils can aid surgeons in performing VATS resections for non-palpable lung nodules deep to the lung surface.Methods: Retrospective analysis of CT-guided microcoil insertions prior to VATS lung resection at a single institution from October 2008 to January 2014.Results: A total of 63 patients were included (37% male, mean age 61.6±11.4 years). Forty-two patients (67%) had a history of smoking, with 10 current smokers. Sixty one (97%) patients underwent wedge resection and 3 (5%) patients had segmentectomy. Three (5%) patients required intra-operative staple line re-resection for positive or close margins. Eleven (17%) patients had a completion lobectomy, 5 of which were during the same anaesthetic. The average time between the CT-guided insertion and start of operation was 136.6±89.0 min, and average operative time was 84.0±53.3 min. The intra-operative complication rate was 5% (n=3), including 1 episode of hemoptysis, and 2 conversions to thoracotomy. The post-operative complication rate was 8% (5 patients), and included 2 air leaks, 1 hemothorax (drop in hemoglobin), 1 post chest tube removal pneumothorax, and one venous infarction of the lingula after lingula-sparing lobectomy requiring completion lobectomy. . Average post-operative length of stay was 2.2 days. A diagnosis was made for all patients.Conclusions: CT-guided microcoil insertion followed by VATS lobectomy is safe, with short operative times, short length of stay and 100% diagnosis of small pulmonary nodules. This technique will become more important in the future with increasing numbers of small nodules detected on CT as part of lung cancer screening programs.

The utility of simultaneous CT-guided localization for multiple pulmonary nodules using microcoil before Video-Assisted Thoracic Surgery

“…For the indeterminate nodules, excision biopsy, which removes the entire nodule at one setting, is an available solution either for patients or physicians, especially for the anxious patients [4]. And a preoperative tumour localization can greatly improve the accuracy of resection and decrease the rate conversion to thoracotomy [5][6][7][8][9][10][11][12][13][14]. CT-guided microcoil localization for pulmonary nodule before video-assisted thoracic surgery (VATS) has been considered as a safe and accurate technique with a high success rate and low complication rate [5][6][7][8][9][10][11][12][13][14].…”

CT-guided Microcoil Pulmonary Nodule Localization prior to Video-assisted Thoracoscopic Surgery: Diagnostic Utility and Recurrence-Free Survival

“…n In Cox regression analysis, nodule distance more than 10 mm from the pleural surface was an independent predictor (hazard ratio, 2.9; P = .03) of time to recurrence. (13). However, to our knowledge, only short-term followup after CT-guided microcoil localization and lung resection has been described to date (7,12,14).…”

Image-guided thoracic surgery in the hybrid operation room

“…The standard procedure at our institution for intraoperative localization of small sized lung nodules is CT-guided metallic microcoil placement performed prior to VATS (2,(11)(12)(13). Preoperative CT-guided placement of a metallic object with intraoperative fluoroscopic assistance has become the common method of localizing small pulmonary nodules, and has been highly successful in localizing nodules with success rates greater than 97% (2,(11)(12)(13). However, the metal tag placement process requires a preoperative invasive procedure that can result in patient discomfort, and complications such as metal tag dislodgement, pneumothorax, and hemoptysis (2).…”

“…The standard procedure at our institution for intraoperative localization of small sized lung nodules is CT-guided metallic microcoil placement performed prior to VATS (2,(11)(12)(13). Classically, these techniques require localization to be performed in the radiology suite followed by surgery in the OR.…”