Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep 29;17(1):241.
doi: 10.1186/s13019-022-02012-4.

Localization of small peripheral pulmonary nodules for surgical resection: a new intraoperative technique in hybrid operating room

Hanbo Yu #  1 , Wenxin Tian #  1 , Yaoguang Sun  1 , Qingjun Wu  1 , Chao Ma  1 , Peng Jiao  1 , Chuan Huang  1 , Donghang Li  1 , Hongfeng Tong  2
Affiliations

Localization of small peripheral pulmonary nodules for surgical resection: a new intraoperative technique in hybrid operating room

Hanbo Yu et al. J Cardiothorac Surg. .

Abstract

Objective: The purpose of this study was to introduce a new feasible and effective intraoperative localization technique for small peripheral pulmonary nodules in hybrid operating room.

Methods: Between June 2020 and June 2021, the intraoperative localization was performed in 27 patients for 35 small pulmonary nodules at our institution. The procedure was undergone under thoracoscopic observation. After making the VATS ports, a titanium clip was clipped at the visceral pleura as near the pulmonary nodule as possible to be a marker for the nodule. VATS resection was performed next.

Results: A total of 27 patients were included in this study, including 6 males and 21 females. The median age was 58 years (range 34-78 years). All surgeries were performed by two-port VATS. A total of 35 pulmonary nodules underwent intraoperative localization. The mean diameter of nodules was 10.6 ± 3.7 mm. The distance of nodules to visceral pleura was 8.3 ± 8.7 mm. The mean localization time was 23.3 ± 3.3 min. The median time of C-arm scanning was 3 (range 2-4) times. The median times for clipping were 2 (range 1-3) times. All the nodules were localized successfully and resected precisely. No VATS were converted to thoracotomy. There were no complications related to localization procedures.

Conclusions: This new intraoperative localization technique was feasible, safe and effective. And also the intraoperative procedure could avoid extra suffering for patients.

Keywords: Intraoperative; Localization; Pulmonary nodule.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A, B Titanium clips (ETHICON Endo-Surgery 1 Ligaclip Extra Ligating Clip Cartridge 6 M Titanium Clips LT 300)
Fig. 2
Fig. 2
Imaging findings of intraoperative localization. A The baseline scanning image of pulmonary nodule located at right upper lobe. B A titanium clip was clipped at the visceral pleura as near the pulmonary nodule as possible under VATS observation. C Re-scanning image of the nodule after the titanium clip was clipped. D The pulmonary nodule was resected with endoscopic staplers using wedge resection. The red arrow showed the titanium clip. The yellow arrow showed the pulmonary nodule
See this image and copyright information in PMC

References

    1. Xu X, Yao Y, Shen Y, et al. Clinical analysis of percutaneous computed tomography-guided hook wire localization of 168 small pulmonary nodules. Ann Thorac Surg. 2015;100(5):1861–1867. doi: 10.1016/j.athoracsur.2015.05.029. - DOI - PubMed
    1. Gruber-Rouh T, Naguib NNN, Beeres M, et al. CT-guided hook-wire localisation prior to video-assisted thoracoscopic surgery of pulmonary lesions. Clin Radiol. 2017;72(10):898.e7–898.e11. doi: 10.1016/j.crad.2017.05.015. - DOI - PubMed
    1. Yao F, Wang J, Yao J, et al. Reevaluation of the efficacy of preoperative computed tomography-guided hook wire localization: a retrospective analysis. Int J Surg. 2018;51:24–30. doi: 10.1016/j.ijsu.2018.01.014. - DOI - PubMed
    1. Yang F, Zhao H, Sui X, et al. Comparative study on preoperative localization techniques using microcoil and hookwire by propensity score matching. Thorac Cancer. 2020;11(6):1386–1395. doi: 10.1111/1759-7714.13365. - DOI - PMC - PubMed
    1. Suzuki K, Nagai K, Yoshida J, et al. Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodules: indications for preoperative marking. Chest. 1999;115(2):563–568. doi: 10.1378/chest.115.2.563. - DOI - PubMed