Dataset Information

Application of computed tomography-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm).

ABSTRACT:

Objective

This study aimed to investigate the safety and efficacy of the computed tomography (CT)-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm) and to identify the risk factors for localization-related complications.

Methods

The medical records of 150 patients with small pulmonary nodules treated from January 2018 to June 2021 were retrospectively analyzed. According to preoperative hook-wire positioning status, they were divided into the localization group (50 cases) or the control group (100 cases). The operation time, intraoperative blood loss, hospital stay, and conversion rate to thoracotomy were recorded and compared between groups. Uni- and multivariate binary logistic regression analysis was used to identify the risk factors for localization-related complications.

Results

A total of 58 nodules were localized in 50 patients in the localization group, and the localization success rate was 98.3% (57/58). In one case, the positioning pin fell off before wedge resection was performed. The mean nodule diameter was 7.05 mm (range, 2.8-10.0 mm), while the mean depth from the pleura was 22.40 mm (range, 5.47-79.47 mm). There were 8 cases (16%) of asymptomatic pneumothorax, 2 (4%) of intrapulmonary hemorrhage, and 1 (2%) of pleural reaction.The mean operation time of the localization group (103.88 ± 41.74 min) was significantly shorter than that of the control group (133.30 ± 45.42 min) (P < 0.05). The mean intraoperative blood loss of the localization group (44.20 ± 34.17 mL) was significantly lower than that of the control group (112.30 ± 219.90 mL) (P < 0.05). The mean hospital stay of the localization group (7.96 ± 2.34 days) was significantly shorter than that of the control group (9.21 ± 3.25 days).Multivariate binary logistic analysis showed that localization times of small pulmonary nodules in the localization group was an independent risk factor for localization-related pneumothorax.

Conclusions

Our results suggest that the CT-guided hook-wire localization technique is beneficial for localizing small pulmonary nodules. Specifically, it is helpful for the diagnosis and treatment of early lung cancer because it can accurately remove lesions, decrease intraoperative blood loss, shorten operation time and hospitalization stay, and reduce thoracotomy conversion rate. Simultaneous positioning of multiple nodules can easily lead to positioning-related pneumothorax.

SUBMITTER: Yang Y

PROVIDER: S-EPMC10074372 | biostudies-literature | 2023 Apr

REPOSITORIES: biostudies-literature

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Publications

Application of computed tomography-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm).

Yang Yuan Y Qin Chenhui C Ma Yue Y Lu Zhongting Z Zhang Yun Y Li Tao T

Journal of cardiothoracic surgery 20230405 1

<h4>Objective</h4>This study aimed to investigate the safety and efficacy of the computed tomography (CT)-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm) and to identify the risk factors for localization-related complications.<h4>Methods</h4>The medical records of 150 patients with small pulmonary nodules treated from January 2018 to June 2021 were retrospectively analyzed. According to preoperative hook-wire positioning status, they were di ...[more]

PMID: 37020219

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Project description:BackgroundThe necessity of localization of pulmonary nodules lies in ensuring the ability to locate the nodule quickly and accurately during surgery, thereby improving the success rate of the operation. The accuracy and risk of preoperative localization of pulmonary nodules need further exploration. Therefore, the purpose of this study was to investigate the factors of accuracy and safety of computed tomography (CT)-guided localization of pulmonary nodules using a flexible wire hook positioner.MethodsIn this retrospective cross-sectional analysis, 281 patients with a single pulmonary nodule underwent video-assisted thoracoscopic surgery (VATS) following localization with a soft hook-wire guided by CT scan from January 2021 to July 2022 at Nanjing Drum Tower Hospital. The patients underwent VATS to remove pulmonary nodules within 24 hours after localization. The demographic, pulmonary nodule, and technical factors were analyzed retrospectively. Univariate and multivariate analysis were used to analyze the identified factors that influence pulmonary nodule localization accuracy and complications.ResultsLocalization was successfully performed in 280 patients, with only 1 patient being excluded due to a displaced positioner and the hook wire failing to enter the lung parenchyma as a result of pneumothorax. Out of the total cases, 191 (68.2%) were accurately positioned in group G0, whereas 89 cases (31.7%) were inaccurately positioned in group G1. Hemorrhage and self-limited hemoptysis were observed in 64 patients (22.8%), whereas pneumothorax was observed in 84 patients (29.9%). There were no serious complications such as air embolism or death. The accuracy of localization was found to be influenced by both the depth of pulmonary nodules [odds ratio (OR) =22.610, 95% confidence interval (CI): 10.351-49.391, P=0.001] and the depth of the needle used (OR =0.322, 95% CI: 0.136-0.765, P=0.010). Additionally, postoperative hemorrhage was found to be affected by several important factors, including the diameter (P=0.036) and depth of the nodule (P=0.011), as well as the thickness of the chest wall (P=0.043) and the depth of the needle used (P=0.005).ConclusionsThe CT-guided flexible wire hook positioner has been found to be a safe and effective device for locating pulmonary nodules. The depth of pulmonary nodules and needle penetration are key factors affecting the accuracy of lung nodule localization under CT guidance and are important factors affecting postoperative bleeding.

Project description:BackgroundPreoperative computed tomography (CT)-guided localization of small pulmonary nodules (SPNs) is the major approach for accurate intraoperative visualization in video-assisted thoracoscopic surgery (VATS). However, this interventional procedure has certain risks and may challenge to less experienced junior doctors. This study aims to evaluate the feasibility and efficacy of robotic-assisted CT-guided preoperative pulmonary nodules localization with the modified hook-wire needles before VATS.MethodsA total of 599 patients with 654 SPNs who preoperatively accepted robotic-assisted CT-guided percutaneous pulmonary localization were respectively enrolled and compared to 90 patients with 94 SPNs who underwent the conventional CT-guided manual localization. The clinical and imaging data including patients' basic information, pulmonary nodule features, location procedure findings, and operation time were analyzed.ResultsThe localization success rate was 96.64% (632/654). The mean time required for marking was 22.85±10.27 min. Anchor of dislodgement occurred in 2 cases (0.31%). Localization-related complications included pneumothorax in 163 cases (27.21%), parenchymal hemorrhage in 222 cases (33.94%), pleural reaction in 3 cases (0.50%), and intercostal vascular hemorrhage in 5 cases (0.83%). Localization and VATS were performed within 24 hours. All devices were successfully retrieved in VATS. Histopathological examination revealed 166 (25.38%) benign nodules and 488 (74.62%) malignant nodules. For patients who received localizations, VATS spent a significantly shorter time, especially the segmentectomy group (93.61±35.72 vs. 167.50±40.70 min, P<0.001). The proportion of pneumothorax in the robotic-assisted group significantly decreased compared with the conventional manual group (27.21% vs. 43.33%, P=0.002).ConclusionsRobotic-assisted CT-guided percutaneous pulmonary nodules hook-wire localization could be effectively helpful for junior less experienced interventional physicians to master the procedure and potentially increase precision.

Dataset Information

Application of computed tomography-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm).

Objective

Methods

Results

Conclusions

Publications

Application of computed tomography-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm).

Similar Datasets

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