La radiologia medica

, Volume 125, Issue 1, pp 24–30 | Cite as

Computed tomography-guided microcoil placement for localizing small pulmonary nodules before uniportal video-assisted thoracoscopic resection

  • Majed RefaiEmail author
  • Marco Andolfi
  • Francesca Barbisan
  • Alberto Roncon
  • Gian Marco Guiducci
  • Francesco Xiumè
  • Michele Salati
  • Michela Tiberi
  • Andrea Giovagnoni
  • Enrico Paci
Chest Radiology



The increasing number of computed tomography (CT) performed allows the more frequent identification of small, solid pulmonary nodules or ground-glass opacities. Video-assisted thoracic surgery (VATS) represents the standard in most lung resections. However, since VATS limit is the digital palpation of the lung parenchyma, many techniques of nodule localization were developed. The aim of this study was to determine the feasibility and safety of CT-guided microcoil insertion followed by uniportal VATS wedge resection (WR).

Materials and methods

Retrospective study in a single institution, including patients undergone CT-guided microcoil insertion prior to uniportal VATS resection between May 2015 and December 2018. The lesion was identified using fluoroscopy.


Forty-six consecutive patients were enrolled (22 male and 24 female). On CT: 5 cases of GGO, 2 cases of semisolid nodules, 39 cases of solid nodules. The median pathologic tumor size was 1.21 cm. Neither conversion to thoracotomy nor microcoil dislodgement was recorded. All patients underwent uniportal VATS WR (9/46 underwent completion lobectomy after frozen section). WR median time was 105 min (range 50–150 min). No patients required intraoperative re-resection for positive margins. After radiological procedure, 1 case of hematoma and 2 cases of pneumothorax were recorded. Four complications occurred in the postoperative period. The mean duration of chest drain and length of stay were 2.9 and 4.6 days, respectively.


CT-guided microcoil insertion followed by uniportal VATS resection was a safe and feasible procedure having a minimal associated complications rate and offering surgeons the ease of localization of small intrapulmonary nodules.


VATS CT-guided microcoil insertion Lung resection Solitary pulmonary nodule Uniportal VATS 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was conducted on already available data and ethical approval was not required dependent on the law and the national ethical guidelines of the country. However, authors have checked with their institution to comply with the specific requirements of their country.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

Supplementary Video 1 Radiological and Surgical procedure. (MP4 89271 kb)


  1. 1.
    Paul S, Altorki NK, Sheng S, Lee PC, Harpole DH, Onaitis MW et al (2010) Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg 139:366–378CrossRefGoogle Scholar
  2. 2.
    Vannucci F, Gonzalez-Rivas D (2016) Is VATS lobectomy standard of care for operable non small-cell lung cancer? Lung Cancer 100:114–119CrossRefGoogle Scholar
  3. 3.
    Whitson BA, Groth SS, Duval SJ, Swanson SJ, Maddaus MA (2008) Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg 86(6):2008–2016CrossRefGoogle Scholar
  4. 4.
    Refai M, Andolfi M (2017) Sabbatini A (2017) Physiopathology aspects of anatomical video-assisted thoracic surgery resections: current status and prospects of development. J Vis Surg 3:161CrossRefGoogle Scholar
  5. 5.
    Kohno T, Fujimori S, Kishi K, Fuji T (2010) Safe and effective minimally invasive approaches for small ground glass opacity. Ann Thorac Surg 89(6):S2114–S2117CrossRefGoogle Scholar
  6. 6.
    National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Clapp JD, Clingan KL et al (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365:395–409CrossRefGoogle Scholar
  7. 7.
    Andolfi M, Potenza R, Capozzi R, Liparulo V, Puma F, Yasufuku K (2016) The role of bronchoscopy in the diagnosis of early lung cancer: a review. J Thorac Dis 8(11):3329–3337CrossRefGoogle Scholar
  8. 8.
    Kidane B, Yasufuku K (2016) Advances in image-guided thoracic surgery. Thorac Surg Clin 26(2):129–138CrossRefGoogle Scholar
  9. 9.
    Rebonato A, Maiettini D, Andolfi M, Fischer MJ, Vannucci J, Metro G et al (2018) CT-guided percutaneous trans-scapular lung biopsy in the diagnosis of peripheral pulmonary lesion nodules of the superior lobes using large needles. Cardiovasc Intervent Radiol 41(2):284–290CrossRefGoogle Scholar
  10. 10.
    Cao C, Manganas C, Ang SC, Peeceeyen S, Yan TD (2013) Video-assisted thoracic surgery versus open thoracotomy for non-small cell lung cancer: a meta-analysis of propensity score-matched patients. Interact CardioVasc Thorac Surg 16:244–249CrossRefGoogle Scholar
  11. 11.
    Yan TD, Black D, Bannon PG, McCaughan BC (2009) Sistematic 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 27:2553–2562CrossRefGoogle Scholar
  12. 12.
    Mayo JR, Clifton JC, Powell TI, English JC, Evans KG, Yee J et al (2009) Lung nodules: cT-guided placement of microcoils to direct video-assisted thoracoscopic surgical resection. Radiology 250:576–585CrossRefGoogle Scholar
  13. 13.
    Donahoe L, Nguyen ET, Chung TB, Kha LC, Cypel M, Darling GE et al (2016) CT-guided microcoil VATS resection of lung nodules: a single centre experience and review of the literature. J Thorac Dis 8(8):1986–1994CrossRefGoogle Scholar
  14. 14.
    Kha LC, Hanneman K, Donahoe L, Chung T, Pierre A, Yasufuku K et al (2016) Safety and efficacy of modified preoperative lung nodule microcoil localization without pleural marking: a pilot study. J Thoracic Imaging 31:15–22CrossRefGoogle Scholar
  15. 15.
    Ujiie H, Kato T, Hu HP, Patel P, Wada H, Fujino K et al (2017) A novel minimally invasive near-infrared thoracoscopic localization technique of small pulmonary nodules: a phase I feasibility trial. J Thorac Cardiovasc Surg 154:702–711CrossRefGoogle Scholar
  16. 16.
    Hanauer M, Perebntes JY, Krueger T, Ris HB, Bize P, Schmidt S et al (2016) Pre-operative localization of solitary pulmonary nodules with computed tomography-guided hook wire: report of 181 patients. J Cardiothorac Surg 11:5CrossRefGoogle Scholar
  17. 17.
    Chul HP, Kyunghwa H, Jin H, Sang ML, Ji WL, Sung HH et al (2017) Comparative effectiveness and safety of preoperative lung localization for pulmonary nodules: a systematic review and meta-analysis. Chest 151(2):316–328CrossRefGoogle Scholar
  18. 18.
    Greenfield AL, Steiner RM, Liu JB, Cohn HE, Goldberg BB, Rawool NM et al (1997) Sonographic guidance for the localization of peripheral pulmonary nodules during thoracoscopy. AJR Am J Roentgenol 168(4):1057–1060CrossRefGoogle Scholar
  19. 19.
    Kondo R, Yoshida K, Hamanaka K, Hashizume M, Ushiyama T, Hyogotani A et al (2009) Intraoperative ultrasonographic localization of pulmonary ground-glass opacities. J Thorac Cardiovasc Surg 138:837–842CrossRefGoogle Scholar
  20. 20.
    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(2):297–300CrossRefGoogle Scholar
  21. 21.
    Kleedehn M, Kim DH, Lee FT, Lubner MG, Robbins JB, Ziemlewicz TJ et al (2016) Preoperative pulmonary nodule localization: a comparison of methylene blue and hookwire techniques. AJR Am J Roentgenol 207(6):1334–1339CrossRefGoogle Scholar
  22. 22.
    Vandoni R, Cuttat JF, Wicky S, Suter M (1998) CT-guided methylene-blue labelling before thoracoscopic resection of pulmonary nodules. Eur J Cardiothorac Surg 148(3):265–270CrossRefGoogle Scholar
  23. 23.
    Hiroaki N, Hirotoshi H (1996) Colored collagen is a long-lasting point marker for small pulmonary nodules in thoracoscopic operations. Ann Thorac Surg 61:1070–1073CrossRefGoogle Scholar
  24. 24.
    Watanabe K, Nomori H, Ohtsuka T, Kaji M, Naruke T, Suemasu K (2006) Usefulness and complications of computed tomography-guided lipiodol marking for fluoroscopy-assisted thoracoscopic resection of small pulmonary nodules: experience with 174 nodules. Thorac Cardiovasc Surg 132:320–324CrossRefGoogle Scholar
  25. 25.
    Ambrogi MC, Melfi F, Zirafa C, Lucchi M, De Liperi A, Mariani G et al (2012) Radio-guided thoracoscopic surgery (RGTS) of small pulmonary nodules. Surg Endosc 26(4):914–919CrossRefGoogle Scholar
  26. 26.
    Galetta D, Bellomi M, Grana C, Spaggiari L (2015) Radio-guided localization and resection of small or III-defined pulmonary lesions. Ann Thorac Surg 100:1175–1180CrossRefGoogle Scholar

Copyright information

© Italian Society of Medical Radiology 2019

Authors and Affiliations

  • Majed Refai
    • 1
    Email author
  • Marco Andolfi
    • 1
  • Francesca Barbisan
    • 2
  • Alberto Roncon
    • 1
  • Gian Marco Guiducci
    • 1
  • Francesco Xiumè
    • 1
  • Michele Salati
    • 1
  • Michela Tiberi
    • 1
  • Andrea Giovagnoni
    • 3
  • Enrico Paci
    • 4
  1. 1.Unit of Thoracic SurgeryAOU Ospedali Riuniti of AnconaAnconaItaly
  2. 2.Unit of Anatomical PathologyAOU Ospedali Riuniti of AnconaAnconaItaly
  3. 3.Department of Radiological SciencesPolytechnic University of Marche, AOU Ospedali Riuniti of AnconaAnconaItaly
  4. 4.Unit of Interventional RadiologyAOU Ospedali Riuniti of AnconaAnconaItaly

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