Video-assisted thoracoscopic solitary pulmonary nodule resection after CT-guided hookwire localization: 43 cases report and literature review

Abstract

Background Peripheral subpleural solitary pulmonary nodules can be visualized and resected easily at thoracoscopy, but it is very difficult to localize deep nonpalpable pulmonary nodules that lie in lung parenchyma. The purpose of this article was to study the effectiveness of video-assisted thoracoscopic solitary pulmonary nodules resection after computed tomography (CT)-guided hookwire localization and to review the literature related to solitary pulmonary nodule diagnosis and treatment. Methods From April 2008 to June 2009, 43 patients with a solitary pulmonary nodule who had undergone CT-guided hookwire localization and video-assisted thoracoscopic surgery (VATS) were studied. Results Two cases were considered unsuccessful, other patients underwent CT-guided hookwire localization successfully, and ten patients had an asymptomatic minimal pneumothorax that did not require any intervention. The diameter of nodules ranged from 5 to 30 mm as measured by CT (mean 17.2 ± 7.5 mm). The distance between the center of nodule and visceral pleural ranged from 2 to 40 mm (mean 18.5 ± 9.3 mm). Of the 41 scheduled VATS procedures, 38 patients underwent thoracoscopic wedge resection. Twenty-two of 41 patients who revealed primary lung cancer after frozen-section examination underwent VATS lobectomy and lymphadenectomy. Three patients were converted to thoracotomy, and a major postoperative hemothorax occurred in one patient. No intra-or postoperative mortality or morbidity was recorded. Conclusions Video-assisted thoracoscopic solitary pulmonary nodule resection after CT-guided hookwire localization is a safe and effective procedure for accurate diagnosis and resection of indeterminate solitary pulmonary nodules.

Combination of CT-guided hookwire localization and video-assisted thoracoscopic surgery for pulmonary nodular lesions: Analysis of 103 patients

“…In this study, all 107 lesions achieved pathological diagnoses. Malignant lesions accounted for 59.8% of cases; this result is similar to 50-70%, which was demonstrated in certain studies (12,14,16,17), but significantly higher than 26%, which was demonstrated in others (6). We suggest that this may be due to the benign diagnoses of certain patients in this study who were selected based on imaging results instead of pathological diagnoses, and the pathological diagnosis of patients lost during follow-up were not obtained.…”

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

“…Studies have showed that pneumothorax and pulmonary hemorrhage, with an incidence of 32.1-68% and 10.3-36%, respectively, in preoperative hook wire placement (22,29,30). Ichinose and colleagues represented similar result, of 500 lesions underwent CT-guided localization, pneumothorax was observed in 49% of the patients immediately after location, only 4.6% require intervention (22), much higher than other study (apply double-thorn hook wire) reported (18.6% and 24.4%) (23). While the pneumothorax induced by double-thorn hook wire is lower than the single semi-rigid hook wire mentioned above.…”

“…The use of methylene blue may also be limited in patients with anthracotic swine mentation for it is difficult to see during VATS. While, hook wires, do not require intraoperative fluoroscopy to detect targets, perform better in resecting small pulmonary nodules via VATS for the short procedure time, precise wedge resection and a better intraoperative manipulation (lift up the lung for wedge resection) (9,10,12,13,22,23). Kastl (8) hold the point that hook wires are easily dislodged, resulting in high failure rates.…”

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

“…A number of groups have reported results using this system, with success rates ranging from 86-100% and dislodgement rates of 0-9% (28)(29)(30)(31)(32). Other hookwire designs have been attempted, with success rates for VATS resection ranging from 88-100% with few complications reported and low rates of dislodgement (33)(34)(35)(36)(37).…”