Simultaneous Multiple Preoperative Localizations of Small Pulmonary Lesions Using a Short Hook Wire and Suture System
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The aim of the study was to retrospectively evaluate simultaneous multiple hook wire placement outcomes before video-assisted thoracoscopic surgery (VATS).
Materials and Methods
Thirty-eight procedures were performed on 35 patients (13 men and 22 women; mean age, 59.9 years) with 80 lung lesions (mean diameter 7.9 mm) who underwent simultaneous multiple hook wire placements for preoperative localizations. The primary endpoints were technical success, complications, procedure duration, and VATS outcome; secondary endpoints included comparisons between technical success rates, complication rates, and procedure durations of the 238 single-placement procedures performed. Complications were also evaluated.
In 35 procedures including 74 lesions, multiple hook wire placements were technically successful; in the remaining three procedures, the second target placement was aborted because of massive pneumothorax after the first placement. Although complications occurred in 34 procedures, no grade 3 or above adverse event was observed. The mean procedure duration was 36.4 ± 11.8 min. Three hook wires dislodged during patient transport to the surgical suite. Seventy-four successfully marked lesions were resected. Six lesions without hook wires were successfully resected after detection by palpation with an additional mini-thoracotomy or using subtle pleural changes as a guide. The complication rates and procedure durations of multiple-placement procedures were significantly higher (P = 0.04) and longer (P < 0.001) than those in the single-placement group, respectively, while the technical success rate was not significantly different (P = 0.051).
Simultaneous multiple hook wire placements before VATS were clinically feasible, but increased the complication rate and lengthened the procedure time.
KeywordsNon-vascular interventions Lung/pulmonary Cancer
Conflict of interest
Toshihiro Iguchi, Takao Hiraki, Hideo Gobara, Hiroyasu Fujiwara, Yusuke Matsui, Seiichiro Sugimoto, Shinichi Toyooka, Takahiro Oto, Shinichiro Miyoshi, and Susumu Kanazawa have no conflicts of interest to declare.
Informed consent was obtained from all individual participants included in the study.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
- 1.Suzuki K, Nagai K, Yoshida J et al (1999) Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodules: indications for preoperative marking. Chest 115(2):563–568. PMID: 22011783Google Scholar
- 2.Saito H, Minamiya Y, Matsuzaki I et al (2002) Indication for preoperative localization of small peripheral pulmonary nodules in thoracoscopic surgery. J Thorac Cardiovasc Surg 124(6):1198–1202. PMID: 12447187Google Scholar
- 3.Kanazawa S, Ando A, Yasui K, Tanaka A, Hiraki Y (1995) Localization of small pulmonary nodules for thoracoscopic resection: use of a newly developed hookwire system. Cardiovasc Intervent Radiol 18(2):122–124. PMID: 7773995Google Scholar
- 4.Miyoshi K, Toyooka S, Gobara H et al (2009) Clinical outcomes of short hook wire and suture marking system in thoracoscopic resection for pulmonary nodules. Eur J Cardiothorac Surg 36(2):378–382. Epub 2009 May 2. PMID: 19414272Google Scholar
- 5.Dendo S, Kanazawa S, Ando A et al (2002) Preoperative localization of small pulmonary lesions with a short hook wire and suture system: experience with 168 producers. Radiology 225(2):511–518. PMID: 12409589Google Scholar
- 6.Kanazawa S, Ando A, Yasui K et al (1998) Localization of pulmonary nodules for thoracoscopic resection: experience with a system using a short hookwire and suture. AJR Am J Roentgenol 170(2):332–334. PMID: 9456940Google Scholar
- 7.Ichinose J, Kohno T, Fujimori S, Harano T, Suzuki S (2013) Efficacy and complications of computed tomography-guided hook wire localization. Ann Thorac Surg 96(4):1203–1208. Epub 2013 Jul 26. PMID: 23895891Google Scholar
- 8.Yoshida Y, Inoh S, Murakawa T, Ota S, Fukayama M, Nakajima J (2011) Preoperative localization of small peripheral pulmonary nodules by percutaneous marking under computed tomography guidance. Interact Cardiovasc Thorac Surg 13(1):25–28. Epub 2011 Apr 11. PMID: 21486758Google Scholar
- 9.Nakashima S, Watanabe A, Obama T, Yamada G, Takahashi H, Higami T (2010) Need for preoperative computed tomography-guided localization in video-assisted thoracoscopic surgery pulmonary resections of metastatic pulmonary nodules. Ann Thorac Surg 89(1):212–218. PMID: 20103238Google Scholar
- 10.Iguchi T, Hiraki T, Gobara H et al (2014) Transfissural route used for preoperative localization of small pulmonary lesions with a short hook wire and suture system. Cardiovasc Intervent Radiol. [Epub ahead of print]Google Scholar
- 11.Seo JM, Lee HY, Kim HK et al (2012) Factors determining successful computed tomography-guided localization of lung nodules. J Thorac Cardiovasc Surg 143(4):809–814. Epub 2011 Nov 20. PMID: 22104686Google Scholar
- 12.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(3):429–433. PMID: 15019673Google Scholar
- 13.Chen S, Zhou J, Zhang J et al (2011) Video-assisted thoracoscopic solitary pulmonary nodule resection after CT-guided hookwire localization: 43 cases report and literature review. Surg Endosc 25(6):1723–1729. Epub 2010 Dec 22. PMID: 21181200Google Scholar
- 14.Huang W, Ye H, Wu Y et al (2014) Hook wire localization of pulmonary pure ground-glass opacities for video-assisted thoracoscopic surgery. Thorac Cardiovasc Surg 62(2):174–178. Epub 2013 Jan 23. PMID: 23344771Google Scholar
- 15.Gonfiotti A, Davini F, Vaggelli L et al (2007) Thoracoscopic localization techniques for patients with solitary pulmonary nodule: hookwire versus radio-guided surgery. Eur J Cardiothorac Surg 32(6):843–847. Epub 2007 Oct 3. PMID: 17913505Google Scholar
- 16.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(1):218–222. PMID: 10421144Google Scholar
- 17.Matsumoto S, Hirata T, Ogawa E et al (2004) Ultrasonographic evaluation of small nodules in the peripheral lung during video-assisted thoracic surgery (VATS). Eur J Cardiothorac Surg 26(3):469–473. PMID: 15302036Google Scholar