Use of a novel claw-suture technique for localization of solitary pulmonary nodules: retrospective study and experience from one center

Abstract

Background: Video-assisted thoracoscopic surgery (VATS) is more effective for diagnosing and treating solitary pulmonary nodules (SPNs). It is sometimes difficult to localize through use of minimally invasive techniques. We evaluated the feasibility, effectiveness, and safety of a novel localization method for SPNs. Here, we describe our technical process, perioperative results, and accumulated experience over the years.

Methods: Between February 2018 and April 2023, a retrospective study of a novel claw-suture localization technique was conducted in a single center. A total of 490 patients participating in the localization of preoperative SPNs were enrolled. An anchor claw device with four hooks and three-colored sutures was used for localizing nodules under computed tomography (CT). We then evaluated the localization process and the outcomes of the operative procedure (success rate, safety, feasibility, and patient comfort).

Results: A total of 510 SPNs were localized before surgery, and the median size of the nodules was 0.70 cm (range, 0.4-2.0 cm). Additionally, 97.1% of these nodules (495 of 510) were localized successfully without dislodgment or device fracture. Types of failures included not meeting the target value of the distance between the claw and lesion (n=12, 2.4%) and displacement of the device (n=3, 0.6%). Pneumothorax (n=63, 12.4%), parenchymal hemorrhage (n=46, 9.0%), and hemothorax (n=1, 0.2%) were the most common complications that did not require further medical treatment. Pleural reactions were reported in 2 patients (0.4%). A notable correlation was also found between the depth of the pulmonary nodules and the incidence of parenchymal hemorrhage (P<0.001). The median length for the entire process was 12 minutes (7-25 minutes). No patients reported significant pain during the localization process, and the device was retrieved with a 100% survival rate after VATS resection.

Conclusions: This method of claw-suture localization is safe, effective, and feasible and can be used to localize SPNs that are challenging to locate before operation.

Keywords: Localization; complications; computed tomography; solitary pulmonary nodules; video-assisted thoracoscopic surgery.

Figure 1

The device consists of a coaxial needle, pusher, anchor claw, tricolored suture, and protection tube.

Figure 2

The main process of localization for patients with SPNs. (A) The coaxial needle is inserted through the chest wall based on the location of the pulmonary nodule after a scout CT scan. (B) CT image shows the pulmonary nodule (white arrow) and the claw (red arrow). (C) The tricolored suture (white arrow) is displayed during the first exploration by VATS. (D) The claw (blue arrow), the tricolored suture (red arrow), and the localized pulmonary nodule (white arrow) are displayed after wedge resection. SPN, small pulmonary nodule; CT, computed tomography; VATS, video-assisted thoracoscopic surgery.

Figure 3

Complications and unsuccessful localization. (A) CT image showing asymptomatic pneumothorax (green arrow), with the claw (red arrow) and nodule (white arrow) in the right upper lobe. (B) CT image showing asymptomatic parenchymal hemorrhage (white arrow), with the claw (red arrow) in the left upper lobe. (C) CT image showing hemothorax (green arrow) with the claw (red arrow) and nodule (white arrow) in the left lower lobe. (D) CT image showing pneumothorax (green arrow) and displacement of the claw (red arrow) pushing against the lung tissue in right middle lobe. CT, computed tomography.