Thoracoscopic localization techniques for patients with solitary pulmonary nodule: hookwire versus radio-guided surgery☆

Gonfiotti, Alessandro; Davini, Federico; Vaggelli, Luca; Francisci, A; Caldarella, Adele; Gigli, P; Jannì, A

doi:10.1016/j.ejcts.2007.09.002

Cited by 112 publications

(122 citation statements)

References 20 publications

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“…Finger palpation for millimeter nodules is also difficult depending on the composition of the lesion and the distance from the pleura (7). Davini et al and Gonfiotti et al introduced the method of radio-guided localization of SPN, the disadvantages of this technique are the requirement of radionuclide injection, a magnetic probe connected to a gamma camera, and increased exposure to radiation (20,21). Intraoperative ultrasound localization of SPN prefers more operator compliance and requires complete collapse of the assessed lung, which is difficult to apply in emphysematous lung.…”

Section: Discussionmentioning

confidence: 99%

Semi-rigid single hook localization the best method for localizing ground glass opacities during video-assisted thoracoscopic surgery: re-aerated swine lung experimental and primary clinical results

et al. 2017

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Background: The aim of this study was to compare the effects of currently available preoperative localization methods, including semi-rigid single hook-wire, double-thorn hook-wire, and microcoil, in localizing the pulmonary nodules, thus to select the best technology to assist video-assisted thoracoscopic surgery (VATS) for small ground glass opacities (GGO).Methods: Preoperative CT-guided localizing techniques including semi-rigid single hook-wire, doublethorn hook-wire and microcoil were used in re-aerated fresh swine lung for location experiments. The advantages and drawbacks of the three positioning technologies were compared, and then the most optimal technique was used in patients with GGO. Technical success and post-operative complications were used as primary endpoints.Results: All three localizing techniques were successfully performed in the re-aerated fresh swine lung.The median tractive force of semi-rigid single hook wire, double-thorn hook wire and microcoil were 6.5, 4.85 and 0.2 N, which measured by a spring dynamometer. The wound sizes in the superficial pleura, caused by unplugging the needles, were 2 mm in double-thorn hook wire, 1 mm in semi-rigid single hook and 1 mm in microcoil, respectively. In patients with GGOs, the semi-rigid hook wires localizations were successfully performed, without any complication that need to be intervened. Dislodgement was reported in one patient before VATS. No major complications related to the preoperative hook wire localization and VATS were observed. Conclusions:We found from our localization experiments in the swine lung that, among the commonly used three localization methods, semi-rigid hook wire showed the best operability and practicability than doublethorn hook wire and microcoil. Preoperative localization of small pulmonary nodules with single semi-rigid hook wire system shows a high success rate, acceptable utility and especially low dislodgement in VATS. IntroductionThe widespread application of low-dose computed tomography (LDCT) has led to a great increase in the identification rate of small pulmonary nodules, especially small ground glass opacities (GGO). GGO is defined as a hazy opacity that does not obscure underlying bronchial structures or pulmonary vessels on CT scans (1). It has been reported that 33-60% GGO was malignant carcinoma when the nodules size ranges from 11-20 mm, while the malignant rate increase to 64-82% when the size grows up greater than 20 mm (2). Although the identification of pulmonary nodules could be effectively accomplished by many imaging modalities, including high-resolution CT, positron emission tomography (PET/CT), and bronchoscopy, whereas the identification of lesions with GGO remains difficult. Thus, more reliable diagnosis and therapeutic options for uncertain pulmonary nodules are still in need (3).Video-assisted thoracoscopic surgery (VATS) is less invasive in diagnosing and treating thoracic lesions, thus how to locate and mark the nodules more precisely before the VATS becomes one of the most important ...

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Section: Discussionmentioning

confidence: 99%

Semi-rigid single hook localization the best method for localizing ground glass opacities during video-assisted thoracoscopic surgery: re-aerated swine lung experimental and primary clinical results

et al. 2017

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“…Size mm 7.5¡3.7 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) Distance from the pleura to superficial depth mm 7.3¡7.5 (0-35)…”

Section: Solid 22mentioning

confidence: 99%

“…However, to our knowledge, none of these methods have been widely adopted because of some negative aspects of the techniques during the operation. The hookwire technique allows precise and quick pre-operative localisation, but has a problem with dislodgement of the hookwire [15][16][17], air embolism and inaccurate resection margins. Lipiodol is a safe and inexpensive material for localisation [18], but lesions cannot be quickly detected.…”

mentioning

confidence: 99%

Needlescopy-assisted resection of pulmonary nodule after dual localisation

Dy¹,

Hk²,

Yk³

et al. 2010

European Respiratory Journal

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The aim of this study was to evaluate the feasibility of dual localisation with hookwire and lipiodol before needlescopy-assisted resection for pulmonary nodule.Computed tomography-guided dual marking was performed on 36 pulmonary nodules of 32 patients and needlescopy-assisted resection was performed monitored by C-arm fluoroscopy.The mean age of the patients was 58¡12 (range 12-77) yrs. The mean size of the nodules was 7.5¡3.7 (3-17) mm. Their mean distance from the pleural surface was 7.3¡7.5 (0-35) mm. There were nine pure ground-glass opacity lesions, five semi-solid lesions and 22 solid lesions. The time of the dual localisation procedure was 13.1¡4.8 (7-23) min. Complications of the marking were pneumothorax in nine patients, and intrapulmonary bleeding in three. One hookwire dislodged during the operation. All nodules were successfully resected under needlescopy without conversion to a conventional thoracoscopy (5 mm or 10 mm thoracoscopy) or a minithoracotomy. There was no complication related to needlescopy-assisted resection.Dual marking with hookwire and lipiodol is a safe and none time consuming procedure, and needlescopy-assisted lung resection for small nodules is technically feasible and useful for histological diagnosis and treatment.

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“…However, dislodgment of the wires or coils after lung collapses is a frustrating problem and was reported to occur in up to 47% of cases who underwent the hookwire marking procedure (17), which remarkably dampens the outcome of marking. As for the microcoil marking technique, the dislodgement rate was comparatively lower reported in the literature (8,18), especially when the coil is used only to label the target nodule but not the surface of the lung (19).…”

Section: Discussionmentioning

confidence: 99%

A novel hybrid technique for localization of subcentimeter lung nodules

Pang

Chen

et al. 2017

J. Thorac. Dis.

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Background: It is technically challenging to locate non-visible, non-palpable subcentimeter ground-glass nodules (GGNs) of lung during video-assisted thoracic surgery (VATS). Computed tomography (CT)-guided marking of small pulmonary nodules using microcoils has been reported to be a practical method of preoperative localization, whereas dislodgement of microcoils remains to be a bothersome complication. The objective of this study was to assess the viability and effectiveness of a newly developed hybrid technique, which combines induced controllable pneumothorax and CT-guided microcoil marking procedure to reduce the risk of microcoil dislodgement.Methods: After induced minor pneumothorax, 35 patients with subcentimeter GGNs underwent CTguided marking with microcoils prior to VATS sublobar resection or lobectomy. Histopathological analysis was performed after surgeries.Results: All of 37 nodules were successfully marked before VATS. Segmentectomy was performed in 8 cases, wedge resection in 19 cases and lobectomy in 8 cases. All nodules were completely removed with marking microcoils. Dislodgement of microcoils was not observed in all cases and mild pulmonary hemorrhage occurred in one case. No other complications occurred. Conclusions:The newly developed hybrid technique which combines induced controllable pneumothorax and CT-guided marking using microcoils was feasible and reliable for VATS resection of subcentimeter GGNs, meanwhile significantly lowered the risk of microcoil dislocation.Keywords: Video-assisted thoracoscopic surgery; lung nodule; localization; computed tomography (CT); J Thorac Dis 2017;9(4):1107-1112 jtd.amegroups.com established, such as hook-wire or microcoil labelling, intraoperative ultrasound scan, methylene blue staining and radio-guided detection. Among them, CT-guided hookwire or microcoil techniques are preferable due to higher sensitivity, less operator dependence and lower complication rate (3-5). Nevertheless, dislodgment of the wire or coil after the lung collapses in the surgery remains a disturbing problem and leads to a relatively higher failure rate of marking (6). In the current study, we developed a novel hybrid technique, which combines induced controllable pneumothorax and CT-guided microcoil marking, to reduce or even eliminate the risk of dislodgment. MethodsBetween May 2015 and March 2016, 35 patients with 37 subcentimeter lung GGNs who underwent preoperative CT-guided microcoil marking and VATS resections at our institution were retrospectively reviewed. Only subpleural lesions, presumed impalpable, with a maximum distance to the pleural surface of 30mm were included. Lesions were incidentally found in 33 patients while they underwent health examination or were being examined for other medical reasons. In 2 patients with a clinical history of malignancy, the lesions were found during follow-up examination. No preoperative pathologic diagnoses were obtained, either by fiberoptic bronchoscopy (FOB) or by CT-guided needle lung biopsies. Preoperative marking procedureT ...

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Thoracoscopic localization techniques for patients with solitary pulmonary nodule: hookwire versus radio-guided surgery☆

Cited by 112 publications

References 20 publications

Semi-rigid single hook localization the best method for localizing ground glass opacities during video-assisted thoracoscopic surgery: re-aerated swine lung experimental and primary clinical results

Semi-rigid single hook localization the best method for localizing ground glass opacities during video-assisted thoracoscopic surgery: re-aerated swine lung experimental and primary clinical results

Needlescopy-assisted resection of pulmonary nodule after dual localisation

A novel hybrid technique for localization of subcentimeter lung nodules

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