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OBJECTIVE: Localization of tiny lung nodules during video-assisted thoracic surgery (VATS) sublobar resection can be challenging. Real-time image-guided hookwire localization of target lesions immediately preceding lung resection in the hybrid operating theatre setting is an emerging approach.
METHODS: We retrospectively reviewed our experience with the real-time image guidance of hookwire insertion for lung nodules 1.5 cm or less using cone-beam computer tomography scan, followed immediately by VATS sublobar resection in the same operating suite and session.
RESULTS: From February 2014 to October 2015, tiny lung nodules of indeterminate nature in 19 consecutive patients with mean nodule size 7.7 ± 3.4 mm, (range 2-15 mm) underwent the procedure. All were localized accurately by hookwire and successfully resected. Five (26.3%) patients developed pneumothorax after hookwire insertion but none required intervention. The mean operative time was 128.5 ± 60.6 minutes, and blood loss 25.5 ± 15.0 mL. The mean chest drain duration was 2.6 ± 0.9 days and postoperative length of stay 3.6 ± 1.7 days. There were no postoperative complications or mortality. There were 14 (73.7%) malignant and 5 benign lesions all with adequate resection margins.
CONCLUSIONS: Real-time image-guided hookwire localization in the hybrid theatre setting is a safe and effective technique for VATS resection of tiny lung nodules. Its potential advantages over the traditional approach warrants further studies.