A segmental labeling technique for non-intubated thoracoscopic anatomical segmentectomy

Preoperative computed tomography-guided coil localization for multiple lung nodules

Background:

Preoperative computed tomography (CT)-guided coil localization can increase the technical success of video-assisted thoracoscopic surgery (VATS)-guided diagnostic wedge resection of lung nodules relative to cases treated without localization. When multiple lung nodules (MLNs) are to be resected, preoperative localization for each lung nodule is required. The aim of this study was to explore the feasibility, safety, and clinical efficacy of preoperative CT-guided coil localization of MLNs.

Methods:

Between November 2015 and July 2019, 31 patients with MLNs were assessed via CT-guided coil localization followed by VATS-guided wedge resection. Rates of technical success for both the localization and wedge resection procedures, as well as data pertaining to patient complication rates and long-term outcomes were recorded and assessed.

Results:

In total, 68 nodules (average of 2.2 nodules/patient) were localized and resected using this approach. Nodules were unilateral and bilateral in 23 and 8 patients, respectively. The rate of CT-guided coil localization technical success for these nodules was 98.5% (67/68), with a technical success rate of single-stage coil localization on a per-patient basis of 96.8% (30/31). Following localization, asymptomatic pneumothorax occurred in four patients (12.9%). The wedge resection technical success rate was 100%. Mean VATS operative time was 167.3 ± 75.2 min, with a mean blood loss of 92.6 ± 61.5 ml. Patients were followed between 3 and 46 months (median: 24 months), with no evidence of new nodules, distant metastases, or postoperative complications in any patients.

Conclusion:

Preoperative CT-guided multiple coil localization can be easily and safely used to guide single-stage VATS diagnostic wedge resection in patients with MLNs.

The reviews of this paper are available via the supplemental material section.

Computed tomography-guided coil localization for sub-fissural lung nodules

This study was designed to explore the safety, feasibility, and clinical efficacy of preoperative computed tomography (CT)-guided coil localization of sub-fissural lung nodules (LNs). A total of 105 LN patients underwent CT-guided coil localization followed by video-assisted thoracoscopic surgery (VATS)-guided wedge resection at our hospital from January 2016 to December 2019. Of these patients, 4 had sub-fissural LNs and were therefore subjected to trans-fissural coil localization procedures. We analyzed data pertaining to the coil localization and VATS procedures in these patients. A total of 4 coils were used to localize 4 LNs in 4 separate patients. One of these patients suffered from parenchymal hemorrhage around the needle path, while one other patient exhibited asymptomatic pneumothorax following coil localization. A thoracoscope was able to successfully visualize the coil tails in all of these patients. There were no instances of coils having been dislodged, and wedge resection was conducted with a 100% technical success rate in these patients. These 4 LNs were subsequently diagnosed as adenocarcinomas in situ (n = 3) and benign nodules (n = 1). CT-guided coil localization can be used to safely and easily localize sub-fissural LNs in patients scheduled to undergo VATS.

Methylene Blue versus Coil-Based Computed Tomography-Guided Localization of Lung Nodules

BACKGROUND

Preoperative computed tomography (CT)-guided localization has been shown to significantly improve lung nodule video-assisted thoracoscopic surgery (VATS)-based wedge resection technical success rates. However, at present, there was insufficient research regarding the optimal approaches to localization of these nodules prior to resection. We aimed to compare the relative clinical efficacy of preoperative CT-guided methylene blue and coil-based lung nodule localization.

METHODS

In total, 91 patients with lung nodules were subjected to either CT-guided methylene blue (n = 34) or coil (n = 57) localization and VATS resection from January 2014 to December 2018. We compared baseline data, localization-associated complication rates, as well as the technical success of localization and resection between these two groups of patients.

RESULTS

In total, 42 lung nodules in 34 patients underwent methylene blue localization, with associated localization and wedge resection technical success rates of 97.6 and 97.6%, respectively. A total of 71 lung nodules in 57 patients underwent coil localization, with associated localization and wedge resection technical success rates of 94.4 and 97.2%, respectively. There were no significant differences in technical success rates of localization or wedge resection between these groups (p = 0.416 and 1.000, respectively). The coil group sustained a longer duration between localization and VATS relative to the methylene blue group (13.2 vs. 2.5 hours, p = 0.003).

CONCLUSION

Both methylene blue and coil localization can be safely and effectively implemented for conducting the diagnostic wedge resection of lung nodules. The coil-based approach is compatible with a longer period of time between localization and VATS procedures.

Computed tomography-guided localization for lung nodules: methylene-blue versus coil localization

PURPOSE

To compare the relative clinical efficacy of preoperative computed tomography (CT)-guided methylene-blue (MB) and coil localization for lung nodules (LNs).

MATERIAL AND METHODS

Between January 2013 and December 2018, a total of 89 patients with LNs underwent CT-guided MB or coil localization and subsequent video-assisted thoracoscopic surgery (VATS)-guided wedge resection in our hospital. We compared the technical success of localization and wedge resection between two groups.

RESULTS

In MB group, 47 LNs in 39 patients were localized, with successful localization and wedge resection rates of 97.9% and 97.9%, respectively. In the coil group, 64 LNs in 50 patients were localized, with successful localization and wedge resection rates of 96.9% and 96.9%, respectively. There were no significant differences in technical success rates of localization and wedge resection between the two groups (p = 1.000 and 1.000). The coil group sustained a longer duration between localization and VATS relative to the MB group (14.4 h vs. 1.6 h, p = .001).

CONCLUSION

Both MB and coil localization were safe and effective techniques to establish a high success rate of VATS-guided wedge resection for LNs. Relative to MB localization, coil localization might be compatible with a longer delay between localization and VATS.

Computed Tomography-Guided Transfissural Coil Localization of Lung Nodules

BACKGROUND

The objective of this study was to evaluate the feasibility, safety, and clinical effectiveness of preoperative computed tomography (CT)-guided transfissural coil localization (TFCL) of subfissural lung nodules.

METHODS

Five patients with lung nodules who underwent CT-guided TFCL before video-assisted thoracoscopic surgery between November 2015 and December 2018 were included. Technical success rates of TFCL and wedge resection were assessed, as well complications and pathological results.

RESULTS

The technical success rate of TFCL was 100%. Two patients experienced parenchymal hemorrhage around the needle path, and two patients experienced asymptomatic pneumothorax after TFCL. The technical success rate of the wedge resection of lung nodules was also 100%. The pathological diagnoses of the five nodules were minimally invasive adenocarcinoma (n = 3), adenocarcinoma in situ (n = 1), and inflammatory nodule (n = 1).

CONCLUSION

CT-guided TFCL is a safe and effective method for the preoperative localization of subfissural lung nodules.