Diagnostic and therapeutic value of computed tomography guided coil placement after digital subtraction angiography guided video-assisted thoracoscopic surgery resection for solitary pulmonary nodules

Comparison of different localization needles and postures in localization of pulmonary nodules

BACKGROUND

With advancements in imaging testing and surgical procedures, an increasing number of nodules with smaller diameters and deeper locations have been deemed suitable for surgical intervention. The preoperative localization of these nodules has become essential. In this retrospective single-center study, we aimed to compare the effectiveness and patient comfort associated with the use of a four-hook needle versus a hook-wire needle for preoperative localization. Additionally, we sought to evaluate the impact of different patient postures on localization effectiveness.

METHODS

We retrospectively analyzed the data of 692 patients following preoperative CT-guided localization. The patients were categorized into different groups based on the type of localization needles used and their respective postures during localization.

RESULTS

There was no statistical difference in total complications between the four-hook needle group and the hook-wire needle group (P > 0.05). The chest pain score in the four-hook needle group was lower than the hook-wire needle group (P = 0.001). The incidence of decoupling in the four-hook needle group was significantly lower than the hook-wire needle group (P < 0.05). The four-hook needle group had better performance in terms of localization operation time, operation time, intraoperative bleeding and first-day drainage (P < 0.05). Compared with the supine and lateral groups, the prone posture group had better performance in total complications and localization operation time, and worse performance in decoupling and chest pain (P < 0.05).

CONCLUSIONS

The four-hook needle has better effectiveness on localization and comfort in patient than the hook-wire needle, which is worthy of clinical promotion and application. The patient's different postures during localization procedure may affect the localization results.

Precise localization of small pulmonary nodules using Pre-VATS with Xper-CT in combination with real-time fluoroscopy-guided coil: report of 15 patients

Purpose: This study aimed to evaluate the value of precise localization of nodules using pre-video-assisted thoracic surgery (VATS) Xper-CT in combination with real-time fluoroscopy-guided coil in the resection of pulmonary nodules using VATS. Materials and Methods: Precise localization of nodules using Xper-CT in combination with real-time fluoroscopy-guided coil and wedge resection using VATS were conducted on 15 patients with 17 small pulmonary nodules (diameter 0.5-1.5 cm) from April 2015 to January 2016. The value of localization was evaluated in terms of procedure time, type of coils, associated complications of localization, and VATS success rate. Results: The success rate of coil localization was found to be 100% in the primary stage (as shown by the CT scan), and the average procedure time was 30-45 min (35.6 ± 3.05 min). No deaths or major complications occurred. Minor complications included five incidents of pneumothorax (the morbidity was 29.4%, 5/17; no patient required chest tube drainage). The dislocation of coil was found in one patient. The results of pathological examination of 17 small pulmonary nodules revealed 11 primary lung cancers, 1 mesenchymal tumor, 3 nonspecific chronic inflammations, 1 hamartoma, and 1 tuberculosis. Two patients with primary lung cancer underwent lobectomy with mediastinal lymph node dissection. Conclusion: The preoperative precise localization of small pulmonary nodules using Xper-CT-guided coil is an effective and safe technique. It helps in the resection of nodules using VATS. It increases the rate of lung wedge resection with few complications and allows for proper diagnosis with a low thoracotomy conversion rate.

Comparison of hook wire versus coil localization for video-assisted thoracoscopic surgery

Background

A hook wire has been most widely used for computed tomography (CT)‐guided localization before video‐assisted thoracoscopic surgery (VATS). However, microcoils have been suggested to replace wires. The purpose of this study was to compare the efficacy, VATS procedure time, and excised volume of specimens of CT‐guided localization using a hook wire and microcoil.

Methods

The medical records of 106 patients with 110 pulmonary nodules who underwent CT‐guided localization using a hook wire (group A) or microcoil (group B) before VATS performed between March 2013 and January 2017 were retrospectively reviewed.

Results

The procedure success rate was 100% in both groups. Dislodgement occurred in four patients in group A and not in group B. Patient pain score was significantly lower for group B than group A (4.0 vs. 6.3; P < 0.001). The VATS success rate was higher in group B than in group A (98.1% vs. 91.1%; P = 0.174). The VATS procedure time was significantly shorter for group B than group A (18.8 vs. 23.6 minutes; P = 0.004). The excised volume of surgical specimens was significantly smaller for group B than group A (8.5 vs. 11.7 cm³; P = 0.043). No major complications related to the localization procedure were noted in either group.

Conclusions

This study showed similar effectiveness of VATS localization between groups. However, microcoil is superior to hook wire for localization of pulmonary nodules in terms of VATS procedure time and excised volume of surgical specimens, with the advantages of no dislodgement and less patient pain.