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. 2016 Aug;8(8):1986-94.
doi: 10.21037/jtd.2016.06.74.

CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature

Laura L Donahoe  1 , Elsie T Nguyen  2 , Tae-Bong Chung  2 , Lan-Chau Kha  2 , Marcelo Cypel  1 , Gail E Darling  1 , Marc de Perrot  1 , Shaf Keshavjee  1 , Andrew F Pierre  1 , Thomas K Waddell  1 , Kazuhiro Yasufuku  1
Affiliations

CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature

Laura L Donahoe et al. J Thorac Dis. 2016 Aug.

Abstract

Background: Video-assisted thoracoscopic surgery (VATS) is standard of care for small lung resections at many centres. Computed tomography (CT)-guided insertion of microcoils can aid surgeons in performing VATS resections for non-palpable lung nodules deep to the lung surface.

Methods: Retrospective analysis of CT-guided microcoil insertions prior to VATS lung resection at a single institution from October 2008 to January 2014.

Results: A total of 63 patients were included (37% male, mean age 61.6±11.4 years). Forty-two patients (67%) had a history of smoking, with 10 current smokers. Sixty one (97%) patients underwent wedge resection and 3 (5%) patients had segmentectomy. Three (5%) patients required intra-operative staple line re-resection for positive or close margins. Eleven (17%) patients had a completion lobectomy, 5 of which were during the same anaesthetic. The average time between the CT-guided insertion and start of operation was 136.6±89.0 min, and average operative time was 84.0±53.3 min. The intra-operative complication rate was 5% (n=3), including 1 episode of hemoptysis, and 2 conversions to thoracotomy. The post-operative complication rate was 8% (5 patients), and included 2 air leaks, 1 hemothorax (drop in hemoglobin), 1 post chest tube removal pneumothorax, and one venous infarction of the lingula after lingula-sparing lobectomy requiring completion lobectomy. . Average post-operative length of stay was 2.2 days. A diagnosis was made for all patients.

Conclusions: CT-guided microcoil insertion followed by VATS lobectomy is safe, with short operative times, short length of stay and 100% diagnosis of small pulmonary nodules. This technique will become more important in the future with increasing numbers of small nodules detected on CT as part of lung cancer screening programs.

Keywords: Video-assisted thoracoscopic surgery (VATS); computed-tomography-guided microcoil localization (CT-guided microcoil localization); lung nodules.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
CT-guided microcoil localization.
Figure 2
Figure 2
Intra-operative fluoroscopy for localization.
See this image and copyright information in PMC

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