Novel CT-guided coil localization of peripheral pulmonary nodules prior to video-assisted thoracoscopic surgery: a pilot study

Abstract

Background Small peripheral lung nodules detected on computed tomography (CT) scans are often difficult to find during thoracoscopic resection, and the present localizing techniques are inefficient or impractical. Purpose To evaluate a novel marking procedure for small peripheral pulmonary nodules using an embolization coil. Material and Methods Patients with small peripheral pulmonary nodules underwent preoperative CT-guided nodule localization using an embolization coil and then resection by fluoroscopically-guided video-assisted thoracoscopic surgery (VATS; group A, n = 22), or, underwent conventional VATS without prior location procedures (group B, n = 16). Comparisons were made between group A and group B concerning operative time, hospitalization, postoperative drainage, and complications. Histopathological diagnoses were made immediately after resection of pulmonary nodules. Results All CT-guided embolization coil fixations were successful. No patient in group A and eight (50%) in group B required conversion to open thoracotomy ( P < 0.0001). No severe complications occurred in either group. Compared with group B, group A had a significantly shorter mean operative time and hospitalization, and less postoperative drainage. Conclusion Preoperative localization of small peripheral pulmonary nodules using CT-guided embolization coil insertion and subsequent fluoroscopically-guided VATS resection is safer and more effective than conventional VATS.