Surgical Endoscopy

, Volume 25, Issue 6, pp 1723–1729 | Cite as

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

  • Sufeng Chen
  • Jianhua Zhou
  • Jie Zhang
  • Hong Hu
  • Xiaoyang Luo
  • Yawei ZhangEmail author
  • Haiquan ChenEmail author



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.


CT 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.


  1. 1.
    Congregado M, Merchan RJ, Gallardo G, Ayarra J, Loscertales J (2008) Video-assisted thoracic surgery (VATS) lobectomy: 13 years’ experience. Surg Endosc 22:1852–1857PubMedCrossRefGoogle Scholar
  2. 2.
    Eichfeld U, Dietrich A, Ott R, Kloeppel R (2005) Video-assisted thoracoscopic surgery for pulmonary nodules after computed tomography-guided marking with a spiral wire. Ann Thorac Surg 79:313–316; discussion 316–317Google Scholar
  3. 3.
    Ost D, Fein AM, Feinsilver SH (2003) Clinical practice. The solitary pulmonary nodule. N Engl J Med 348:2535–2542PubMedCrossRefGoogle Scholar
  4. 4.
    Alzahouri K, Velten M, Arveux P, Woronoff-Lemsi MC, Jolly D, Guillemin F (2008) Management of SPN in France. Pathways for definitive diagnosis of solitary pulmonary nodule: a multicentre study in 18 French districts. BMC Cancer 8:93PubMedCrossRefGoogle Scholar
  5. 5.
    Raftopoulos Y, Furey WW, Kacey DJ, Podbielski FJ (2000) Tumor implantation after computed tomography-guided biopsy of lung cancer. J Thorac Cardiovasc Surg 119:1288–1289PubMedCrossRefGoogle Scholar
  6. 6.
    Kim JH, Kim YT, Lim HK, Kim YH, Sung SW (2003) Management for chest wall implantation of non-small cell lung cancer after fine-needle aspiration biopsy. Eur J Cardiothorac Surg 23:828–832PubMedCrossRefGoogle Scholar
  7. 7.
    Tan BB, Flaherty KR, Kazerooni EA, Iannettoni MD (2003) The solitary pulmonary nodule. Chest 123:89S–96SPubMedCrossRefGoogle Scholar
  8. 8.
    Laisaar T, Vooder T, Umbleja T (2008) Thoracoscopic resection of a solitary pulmonary nodule in patients with a known history of malignancy. Thorac Cardiovasc Surg 56:418–421PubMedCrossRefGoogle Scholar
  9. 9.
    Mery CM, Pappas AN, Bueno R, Mentzer SJ, Lukanich JM, Sugarbaker DJ, Jaklitsch MT (2004) Relationship between a history of antecedent cancer and the probability of malignancy for a solitary pulmonary nodule. Chest 125:2175–2181PubMedCrossRefGoogle Scholar
  10. 10.
    Walker WS, Codispoti M, Soon SY, Stamenkovic S, Carnochan F, Pugh G (2003) Long-term outcomes following VATS lobectomy for non-small cell bronchogenic carcinoma. Eur J Cardiothorac Surg 23:397–402PubMedCrossRefGoogle Scholar
  11. 11.
    Oda M, Matsumoto I, Tamura M, Fujimori H, Shimizu Y, Matsunoki A, Ishikawa N, Ohtake H, Watanabe G (2009) Video-assisted thoracic surgery for clinical stage I lung cancer. Kyobu Geka 62:281–284PubMedGoogle Scholar
  12. 12.
    Yan TD, Black D, Bannon PG, McCaughan BC (2009) Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol 27:2553–2562PubMedCrossRefGoogle Scholar
  13. 13.
    Suzuki K, Nagai K, Yoshida J, Ohmatsu H, Takahashi K, Nishimura M, Nishiwaki Y (1999) Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodules: indications for preoperative marking. Chest 115:563–568PubMedCrossRefGoogle Scholar
  14. 14.
    Lenglinger FX, Schwarz CD, Artmann W (1994) Localization of pulmonary nodules before thoracoscopic surgery: value of percutaneous staining with methylene blue. AJR Am J Roentgenol 163:297–300PubMedGoogle Scholar
  15. 15.
    Willekes L, Boutros C, Goldfarb MA (2008) VATS intraoperative tattooing to facilitate solitary pulmonary nodule resection. J Cardiothorac Surg 3:13PubMedCrossRefGoogle Scholar
  16. 16.
    Miyoshi T, Kondo K, Takizawa H, Kenzaki K, Fujino H, Sakiyama S, Tangoku A (2006) Fluoroscopy-assisted thoracoscopic resection of pulmonary nodules after computed tomography-guided bronchoscopic metallic coil marking. J Thorac Cardiovasc Surg 131:704–710PubMedCrossRefGoogle Scholar
  17. 17.
    Nakano N, Miyauchi K, Imagawa H, Kawachi K (2004) Immediate localization using ultrasound-guided hookwire marking of peripheral lung tumors in the operating room. Interact Cardiovasc Thorac Surg 3:104–106PubMedCrossRefGoogle Scholar
  18. 18.
    Santambrogio R, Montorsi M, Bianchi P, Mantovani A, Ghelma F, Mezzetti M (1999) Intraoperative ultrasound during thoracoscopic procedures for solitary pulmonary nodules. Ann Thorac Surg 68:218–222PubMedCrossRefGoogle Scholar
  19. 19.
    Kastl S, Langwieler TE, Krupski-Berdien G, Demir E, Izbicki JR (2006) Percutaneous localization of pulmonary nodules prior to thoracoscopic surgery by CT-guided hook-wire. Anticancer Res 26:3123–3126PubMedGoogle Scholar
  20. 20.
    Chen W, Chen L, Qiang G, Chen Z, Jing J, Xiong S (2007) Using an image-guided navigation system for localization of small pulmonary nodules before thoracoscopic surgery: a feasibility study. Surg Endosc 21:1883–1886PubMedCrossRefGoogle Scholar
  21. 21.
    Kerrigan DC, Spence PA, Crittenden MD, Tripp MD (1992) Methylene blue guidance for simplified resection of a lung lesion. Ann Thorac Surg 53:163–164PubMedCrossRefGoogle Scholar
  22. 22.
    Davini F, Gonfiotti A, Vaggelli L, De Francisci A, Gigli P, Janni A (2006) Thoracoscopic localization techniques for patients with solitary pulmonary nodule: radioguided surgery versus hookwire localization. J Cardiovasc Surg (Torino) 47:355–359Google Scholar
  23. 23.
    Gonfiotti A, Davini F, Vaggelli L, De Francisci A, Caldarella A, Gigli PM, Janni A (2007) Thoracoscopic localization techniques for patients with solitary pulmonary nodule: hookwire versus radio-guided surgery. Eur J Cardiothorac Surg 32:843–847PubMedCrossRefGoogle Scholar
  24. 24.
    Pittet O, Christodoulou M, Pezzetta E, Schmidt S, Schnyder P, Ris HB (2007) Video-assisted thoracoscopic resection of a small pulmonary nodule after computed tomography-guided localization with a hook-wire system. Experience in 45 consecutive patients. World J Surg 31:575–578PubMedCrossRefGoogle Scholar
  25. 25.
    Chen YR, Yeow KM, Lee JY, Su IH, Chu SY, Lee CH, Cheung YC, Liu HP (2007) CT-guided hook wire localization of subpleural lung lesions for video-assisted thoracoscopic surgery (VATS). J Formos Med Assoc 106:911–918PubMedCrossRefGoogle Scholar
  26. 26.
    Poretti FP, Brunner E, Vorwerk D (2002) Simple localization of peripheral pulmonary nodules: CT-guided percutaneous hook-wire localization. Rofo 174:202–207PubMedGoogle Scholar
  27. 27.
    Guermazi A, Miaux Y, Genant HK, Peterfy CG (2002) Be sure to insert—appropriately and safely—a hookwire!. AJR Am J Roentgenol 178:764–765PubMedGoogle Scholar
  28. 28.
    Thaete FL, Peterson MS, Plunkett MB, Ferson PF, Keenan RJ, Landreneau RJ (1999) Computed tomography-guided wire localization of pulmonary lesions before thoracoscopic resection: results in 101 cases. J Thorac Imaging 14:90–98PubMedCrossRefGoogle Scholar
  29. 29.
    Ciriaco P, Negri G, Puglisi A, Nicoletti R, Del Maschio A, Zannini P (2004) Video-assisted thoracoscopic surgery for pulmonary nodules: rationale for preoperative computed tomography-guided hookwire localization. Eur J Cardiothorac Surg 25:429–433PubMedCrossRefGoogle Scholar
  30. 30.
    Hirai S, Hamanaka Y, Mitsui N, Morifuji K, Uegami S (2006) Role of video-assisted thoracic surgery for the diagnosis of indeterminate pulmonary nodule. Ann Thorac Cardiovasc Surg 12:388–392PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Thoracic SurgeryCancer Hospital of Fudan UniversityShanghaiChina
  2. 2.Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina

Personalised recommendations