Computed tomography-guided pulmonary nodule localization before thoracoscopic resection

Purpose: To assess the success rate and complication rate of a CT-guided pulmonary nodule-marker system before thoracoscopic resection.

Material and Methods: In 24 patients (15 M, 9 F; age range, 18-71 years) a total of 25 pulmonary nodules (in 1 patient 2 lesions simultaneously) were marked with a special wire under CT-guidance and then thoracoscopically resected. We evaluated lesion size, lesion distance to the pleura, the time of intervention, complications, and thoracoscopic success rate.

Results: Mean lesion size was 7?mm (range 4-15?mm) and mean lesional distance to the pleura was 13?mm (range 2-31?mm). The pulmonary nodule-marker system was positioned successfully in all 25 pulmonary nodules within 5-11?min (mean 7.5?min). Minimal pneumothoraces were observed in five patients with no requirements of chest drains. In addition, no bleeding complications or hematothorax were observed. All 25 pulmonary nodules could be resected thoracoscopically. However, in one patient (4%), the guide-wire dislocated during thoracoscopy, but the lesion could be successfully resected during thoracoscopy.

Conclusion: The CT-guided placement of the pulmonary nodule-marker system used here offers a safe and accurate guide for the localization of small pulmonary nodules during thoracoscopic resection.