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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2014 Oct 16

language: English

Thoracoscopic resection of suspected metastatic pulmonary nodules after microcoil localization technique, a prospective study

Hajjar W. M., Alnassar S., Almousa O., Rahal S., Al-Aqeed A., Iftikhar A., Aboreid F.

Department of Surgery, College of Medicine, King Saud University, King Khalid University Hospital Riyadh, Saudi Arabia


AIM: Newly developed pulmonary nodules less than 20 mm in diameter in patients with a previous history of malignancy is highly suspicious to be metastatic. In this study we evaluate a new technique of computed tomography guided microcoils localization to facilitate thoracoscopic resection of deep pulmonary nodules.
METHODS: Seventy-­four patients, who were discovered to have lung nodules (less than 20 mm) during follow up and were referred to the thoracic surgical unit in our institute from Sept. 2008 till Sept 2013, underwent CT-­scan guided Microcoil localization followed by Video-­Assisted thoracoscopic surgery (VATS) where the nodule along with micro coil was excised completely using endostaplers guided by fluoroscopy.
RESULTS: CT-­scan guided microcoil placement was successful in all cases; however, two coils were displaced at the time of lung isolation. There was no mortality, no bleeding or hemothorax, or massive pneumothorax, no air emboli or any other post procedural complications, but a small pneumothorax occurred in 3 patients, who were managed conservatively. Mean operative time was 52.5 ± 24.5 minutes, microcoil localization time was 43 ± 13 minutes, and fluoroscopy time was 3± 1.2 minutes. The resected nodules were inflammatory or granulomatous disease in 17 patients (23%), benign lung lesions in 12 patients(16.2%), metastatic in origin in 43 patients (58.1%), and 2 patients (2.7%) primary lung cancer.
CONCLUSION: This study demonstrates that CT-­guided microcoil localization is feasible, safe, and effective. It increases the success rate of VATS resection of pulmonary nodules to .(100% compared with the reported 37% success rate with the non-­guided approach. (2)

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