Background: Video-assisted thoracic surgery (VATS) provides a minimally invasive means
to resect pulmonary nodules. However, small solitary pulmonary nodules (SPN) remain problematic
during VATS owing to unpredictable visualization and palpation. Intraoperative small SPN localization
provides a more obvious target to facilitate intraoperative resection. This study is a single-institution
validation of intraoperative CT-guided hook wire localization for small SPN in VATS.
Methods: The records of 42 patients with 45 small SPN underwent intraoperative CT-guided doublethorn
hook wire localization prior to video-assisted thoracoscopic wedge resection from September
2008 and August 2013 was reviewed retrospectively. All patients received VATS within 10minutes after wire
localizations. The efficacy of intraoperative localization was evaluated in terms of procedure time, VATS success rate and
associated complications of localization.
Results: A total of 42 patients (30 males, 12 females) underwent 45 VATS resections, with simultaneous bilateral nodule
resections performed in 3 patients. Nodule diameters ranged from 4 mm to 20 mm (mean, 6.8 mm). The distance of the
lung lesions to the nearest pleural surfaces ranged from 2 mm to 30 mm (mean, 12.5 mm). All resections of the lesions
(100%). guided by the inserted hook wires were successfully performed by VATS The mean procedure time for CTguided
hook wire localization was 8.4 minutes (range: 6-15 minutes). The mean procedure time for VATS was 52 minutes
(range: 14-98 minutes). Pathologic examination revealed 18 primary lung cancers, 21 atypical adenomatous hyperplasia
(AAH), 4 metastases, 2 nonspecific chronic inflammation. No major complications related to the intraoperative hook wire
localization and VATS were noted.
Conclusion: Intraoperative CT-guided hook wire localization is useful, helps in precise small SPN localization in VATS
wedge resection, and has a very low rate of minor complications.