Percutaneous Localization of Pulmonary Nodules Prior to Thoracoscopic Surgery by CT-guided Hook-wire

Abstract

Background: When performing thoracoscopic surgery in patients with small pulmonary nodules, intra-operative localization can be difficult and time-consuming. The percutaneous localization of suspicious intrapulmonary lesions was evaluated pre-operatively to facilitate the resection of the lesion and to avoid thoracotomy. Materials and Methods: Thoracoscopies were performed in 13 patients with intrapulmonary nodules previously localized by CT-scan and flagged percutaneously with a hook-wire. Immediately after the procedure, the patient was transferred to the operating room and thoracoscopic pulmonary wedge resection was performed. Results: All the nodules were properly identified. The time to position the wire was 20-30 min and thoracotomy could be avoided in all patients. The nodules were 0.5 cm - 6 cm in size and situated 1 cm - 4 cm subpleurally. Conclusion: Guide-wire identification of an intrapulmonary nodule is a safe, elegant, time-saving and reliable method. The lack of manual examination of pulmonary parenchyma in thoracoscopy is compensated for by precise pre-operative localization.