Modified hook‐wire placement technique for localizing multiple pulmonary nodules

Abstract

Background The localization of multiple pulmonary nodules is challenging due to a high incidence of pneumothorax after each needle insertion into lung parenchyma. The aim of the current study is to verify the safety and effectiveness of a modified technique utilizing simultaneous Hookwire placement to localize multiple lesions. Methods The proposed method comprises a row of metal wires, perpendicular insertion, simultaneous release of Hookwire, and a lateral position to modify a conventional localizing technique. From January 2015 to August 2016, 23 patients were subjected to the modified technique group (Group A), while 53 patients in the conventional group (Group B). Success rates, procedural parameters, and complications were recorded and analyzed. Results Compared with Group B, Group A had higher success rate of lesion (96.7% vs 83.5%, P = 0.009), lower numbers of CT scans (2.91 vs 5.59, P < 0.001), shorter procedure duration (13.83 minutes vs 22.68 minutes, P < 0.001), and shorter distance between localizers and lesions (4.88 vs 6.29, P = 0.006). The incidence of pneumothorax in Group A was lower (21.8% vs 54.7%, P = 0.008), while lung hemorrhage was not significantly different ( P = 0.735). Lesion number and pneumothorax were risk factors for failure in multiple localizations. Conclusions The modified Hookwire placement technique was feasible and successful, which was associated with fewer computed tomography scans, shorter procedure duration, and a lower incidence of pneumothorax.

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

“…Actually, with respect to simultaneous localization of multiple pulmonary nodules, the potential challenges and problems have been well described in previous studies [15][16][17][18][19], even though a different localization technique-hook wire has been adopted. Compared to single localization, simultaneously targeting multiple nodules means repetitive procedures in a short time, which is not only associated with potential increased risk of failure and complication but also a tough process both for operators and patients.…”

“…Although the simultaneous localization has been performed or mentioned in prior studies [15][16][17][18][19], few studies have focused on the microcoil utility in simultaneous localization before VATS [19]. Thus, we retrospectively summarized the experiences of CT-guided microcoil localization in lung nodules and evaluated the efficacy and safety of microcoil utility in simultaneous localization.…”

Preoperative computed tomography-guided coil localization for multiple lung nodules

“…[7][8][9] To ensure that technical success rates for multiple wedge resections remain high, it is essential that all target nodules be preoperatively localized through a CT-based technique. 7,8,10 Although some peripheral small solid nodules could be palpated, 4 detection of these small nodules was timeconsuming. When the preoperative localization was performed, the visualization of the localized marking could directly guide us to find the nodules.…”

Ultralow dose computed tomography protocol for hook‐wire localization of solitary pulmonary nodules prior to video‐assisted thoracoscopic surgery

“…Recently, a modified hook-wire placement technique was successfully applied to locate multiple pulmonary nodules. 16 The mean success rate of HWL is reported as 0.98 (95% confidence interval 0.97-0.99). 17 In our case, the success rate was 100%, which was consistent with the rate reported by Gruber-Rouh et al 18 Dislodgement is a major disadvantage of the HWL procedure.…”

“…Among these methods, CT‐guided HWL is the most commonly used method, with a high technique success rate, low thoracotomy conversion rate, and few postoperative complications. Recently, a modified hook‐wire placement technique was successfully applied to locate multiple pulmonary nodules . The mean success rate of HWL is reported as 0.98 (95% confidence interval 0.97–0.99) .…”