Successful Thoracoscopic Resection of Pulmonary Metastasis Less Than 1 cm in Size Utilizing Preoperative CT-Guided Wire Localization

Abstract

Preoperative computer tomography (CT) guidance localization utilizing a percutaneous guidewire before thoracoscopic resection is safe and beneficial in children with pulmonary nodules less than 1 cm in size or located deep in the pleural surface. This paper describes a successful thoracoscopic resection of a little subpleural pulmonary metastasis of a Wilm's tumor in a 5-year-old child utilizing preoperative CT-guided wire localization of the lesion. The thoracoscopic procedure was performed with the use of two ports, the nodule was easily localized,and the pulmonary wedge resection was made by the use of an endo-GIA linear stapling device after guidewire removal. The operating time was 45 minutes and the chest tube was removed after 48 hours. The postoperative course was uneventful, and the child was discharged on postoperative day 5. This technique allows the surgeon to resect little pulmonary nodules, avoiding the need of more invasive procedures as standard thoracotomy without adjunctive morbidity and with good cosmetic results.

CT-Guided Percutaneous Transthoracic Localization of Pulmonary Nodules Prior to Video-Assisted Thoracoscopic Surgery Using Barium Suspension

“…Various materials have been used for the percutaneous localization of nodules under CT guidance, including the injection of a methylene blue solution (15), colored collagen (16), or lipiodol (17-19), as well as the introduction of a metallic hook-wire (7, 20, 21) or metallic microcoils (22, 23). They all present some problems.…”

Pediatric oncologic endosurgery

“…In fact, technical advances in imaging have led to an increased detection of small lung nodules of uncertain histologic nature. The development of localization techniques has enabled the resection of even small lung nodules by thoracoscopy 19 , decreasing the need for a potentially morbid, open thoracotomy. Localizing techniques include placing a CT-guided wire into the lesion, or tatooing the lesions on the pulmonary surface using the patient’s own blood or methylene blue 20 .…”