Journal of the Formosan Medical Association
Volume 106, Issue 11 , Pages 911-918, November 2007

CT-guided Hook Wire Localization of Subpleural Lung Lesions for Video-assisted Thoracoscopic Surgery (VATS)

  • Yu-Ruei Chen

      Affiliations

    • Departments of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
    • ,
  • Kee-Min Yeow

      Affiliations

    • Departments of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Kee-Min Yeow, Department of Imaging and Intervention, Chang Gung Memorial Hospital, 199 Tun Hua North Road, Taipei, Taiwan
    • ,
  • Jui-Ying Lee

      Affiliations

    • Department of Medical Imaging, Far Eastern Memorial Hospital, Taipei, Taoyuan, Taiwan
    • ,
  • I-Hao Su

      Affiliations

    • Departments of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
    • ,
  • Sung-Yu Chu

      Affiliations

    • Departments of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
    • ,
  • Chih-Hui Lee

      Affiliations

    • Departments of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
    • ,
  • Yun-Chung Cheung

      Affiliations

    • Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
    • ,
  • Hui-Ping Liu

      Affiliations

    • Department of Thoracic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan

Received 15 March 2007; received in revised form 30 April 2007; accepted 7 August 2007.

Article Outline

Background/Purpose

Histologic diagnosis of suspicious small subpleural lung lesions is difficult and often impossible using existing image-guided needle biopsy techniques including video-assisted thoracoscopic wedge resection. Preoperative lung lesion localization provides a more obvious target to facilitate intraoperative resection. This study reviewed the indications, results and complications of CT-guided hook wire localization for subpleural lung lesions in video-assisted thoracoscopic surgery (VATS).

Methods

Between February 2001 and January 2007, 41 patients (20 males, 21 females; mean age, 52.5 ± 5.1 years) with 43 subpleural pulmonary lesions underwent preoperative CT-guided double-thorn hook wire localization prior to video-assisted thoracoscopic wedge resection. Nodule diameters ranged from 2 mm to 26 mm (mean, 9.7 ± 1.6 mm). The distance of the lung lesions from the nearest pleural surfaces ranged from 2 mm to 30 mm (mean, 9.6 ± 2.0 mm). Patients then received VATS within 5 hours. The efficacy of preoperative localization was evaluated in terms of procedure time, VATS success rate and associated complications of localization.

Results

Forty-three wedge resections of the lungs containing 43 subpleural lung lesions as guided or assisted by the inserted hook wires were successfully performed in 41 VATS procedures (41 of 43 procedures, 95.3%). The mean procedure time for preoperative CT-guided hook wire localization was 30.4 ± 2.8 minutes. Eight patients had asymptomatic minimal pneumothoraces (18.6%); six patients had minimal needle tract parenchymal hemorrhages (13.9%) and one patient (2.3%) had an estimated 100 mL of hemothorax due to a small intercostal artery bleed that was cauterized during operation. The mean procedure time for VATS was 103 ± 9.7 minutes (range, 44–198 minutes). Pathologic examination revealed seven primary lung cancers, 11 metastases, one hemangioma, 19 definite non-neoplastic pathologies, two nonspecific chronic inflammation, and three metallic foreign bodies. Diagnostic yield was 95%. No major complications related to the preoperative hook wire localization and VATS were noted.

Conclusion

CT-guided hook wire fixation is useful, helps in precise lesion localization in VATS wedge resection, and has a low rate of minor complications.

Key Words:  CT-guidance , hook wire , peripheral pulmonary lesions , video-assisted thoracoscopic surgery

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PII: S0929-6646(08)60061-3

doi:10.1016/S0929-6646(08)60061-3

Journal of the Formosan Medical Association
Volume 106, Issue 11 , Pages 911-918, November 2007

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