Video-assisted thoracoscopic solitary pulmonary nodule resection after CT-guided hookwire localization: 43 cases report and literature review
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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.
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.
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.
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.
KeywordsCT guidance Hookwire Solitary pulmonary nodule Video-assisted thoracoscopic surgery
We thank the Department of Histopathology and the Department of Medical Imaging at the Shanghai Cancer Hospital, Shang, China, for their assistance with this work.
Drs. Sufeng Chen, Jianhua Zhou, Jie Zhang, Hong Hu, Xiaoyang Luo, Yawei Zhang, and Haiquan Chen have no conflicts of interest or financial ties to disclose.
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