Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2015

01-01-2015 | Thoracic Oncology

Needlescopic Resection of Small and Superficial Pulmonary Nodule After Computed Tomographic Fluoroscopy-Guided Dual Localization with Radiotracer and Hookwire

Authors: Kyung Won Doo, MD, Hwan Seok Yong, MD, PhD, Hyun Koo Kim, MD, PhD, Sungeun Kim, MD, PhD, Eun-Young Kang, MD, PhD, Young Ho Choi, MD, PhD

Published in: Annals of Surgical Oncology | Issue 1/2015

Login to get access

Abstract

Purpose

The aim of this study was to evaluate the feasibility of a needlescopic resection for small and superficial pulmonary nodules after dual localization with radiotracer and hookwire.

Methods

Computed tomography (CT) fluoroscopy-guided dual marking with hookwire and 99mTc-phytate was performed on 36 small and superficial pulmonary nodules of 34 patients, just before the needlescopic procedure. This method was carried out through one introducer needle, after an initial single puncture. After detection of the hookwire-marked site through needlescopy, the precise lesion was confirmed using a thoracoscopic gamma probe by calculating the highest radioactivity. The pulmonary nodule was resected and diagnosed by pathologic examination.

Results

The mean size of the nodules was 12.5 ± 5.4 mm (range 3–20), and their mean distance from the pleural surface was 5.6 ± 5.8 mm (range 0–18.7). The time of the dual localization procedure was 10.8 ± 3.6 min (range 5–18). Pneumothorax was developed in 6 of 34 patients (17.6 %) after preoperative localization, but did not require any treatment. Seven hookwires dislodged during the operation. Nevertheless, radiotracer markings detected on a gamma probe guided a successful wedge resection without difficulty in all seven cases. All nodules were successfully resected under needlescopy, except conversion to the 5-mm-sized thoracoscopy in four patients due to pleural adhesion.

Conclusions

Dual marking with radiotracer and hookwire under CT fluoroscopy is a safe and not time-consuming procedure, and has made needlescopy-assisted lung resection for small and superficial nodules or ground-glass opacity lesions easier, more convenient, and less hazardous.
Appendix
Available only for authorised users
Literature
1.
Yeow KM, Tsay PK, Cheung YC, Lui KW, Pan KT, Chou AS. Factors affecting diagnostic accuracy of CT-guided coaxial cutting needle lung biopsy: retrospective analysis of 631 procedures. J Vasc Interv Radiol. 2003;14(5):581–8.PubMedCrossRef
2.
Ikeda Y, Miyoshi S, Seki N, Kobayashi S, Umezu H, Tamura M. Needlescopic operation for partial lung resection. Ann Thorac Surg. 2003;75(2):599–601.PubMedCrossRef
3.
Kim HK, Jo WM, Jung JH, et al. Needlescopic lung biopsy for interstitial lung disease and indeterminate pulmonary nodules: a report on 65 cases. Ann Thorac Surg. 2008;86(4):1098–103.PubMedCrossRef
4.
Chen YR, Yeow KM, Lee JY, et al. CT-guided hook wire localization of subpleural lung lesions for video-assisted thoracoscopic surgery (VATS). J Formos Med Assoc. 2007;106(11):911–8.PubMedCrossRef
5.
Nomori H, Horio H, Naruke T, Suemasu K. Fluoroscopy-assisted thoracoscopic resection of lung nodules marked with lipiodol. Ann Thorac Surg. 2002;74(1):170–3.PubMedCrossRef
6.
Sugi K, Kaneda Y, Hirasawa K, Kunitani N. Radioisotope marking under CT guidance and localization using a handheld gamma probe for small or indistinct pulmonary lesions. Chest. 2003;124(1):155–8.PubMedCrossRef
7.
Mayo JR, Clifton JC, Powell TI, et al. Lung nodules: CT-guided placement of microcoils to direct video-assisted thoracoscopic surgical resection. Radiology. 2009;250(2):576–85.PubMedCrossRef
8.
Magistrelli P, D’Ambra L, Berti S, Feleppa C, Stefanini T, Falco E. Use of India ink during preoperative computed tomography localization of small peripheral undiagnosed pulmonary nodules for thoracoscopic resection. World J Surg. 2009;33(7):1421–4.PubMedCrossRef
9.
Partik BL, Leung AN, Müller MR, et al. Using a dedicated lung-marker system for localization of pulmonary nodules before thoracoscopic surgery. AJR Am J Roentgenol. 2003;180(3):805–9.PubMedCrossRef
10.
Gonfiotti A, Davini F, Vaggelli L, et al. Thoracoscopic localization techniques for patients with solitary pulmonary nodule: hookwire versus radio-guided surgery. Eur J Cardiothorac Surg. 2007;32(6):843–7.PubMedCrossRef
11.
Kang DY, Kim HK, Kim YK, Yong HS, Kang EY, Choi YH. Needlescopy-assisted resection of pulmonary nodule after dual localisation. Eur Respir J. 2011;37(1):13–7.PubMedCrossRef
12.
Stiles BM, Altes TA, Jones DR, et al. Clinical experience with radiotracer-guided thoracoscopic biopsy of small, indeterminate lung nodules. Ann Thorac Surg. 2006;82(4):1191–6.PubMedCrossRef
13.
Grogan EL, Jones DR, Kozower BD, Simmons WD, Daniel TM. Identification of small lung nodules: technique of radiotracer-guided thoracoscopic biopsy. Ann Thorac Surg. 2008;85(2):S772–7.PubMedCrossRef
14.
Kim H, Park CM, Koh JM, Lee SM, Goo JM. Pulmonary subsolid nodules: what radiologists need to know about the imaging features and management strategy. Diagn Interv Radiol. 2014;20(1):47–57.PubMed
15.
Goldstein NS, Ferkowicz M, Kestin L, Chmielewski GW, Welsh RJ. Wedge resection margin distances and residual adenocarcinoma in lobectomy specimens. Am J Clin Pathol. 2003;120(5):720–4.PubMedCrossRef
16.
Suzuki K, Nagai K, Yoshida J, et al. Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodules: indications for preoperative marking. Chest. 1999;115(2):563–8.PubMedCrossRef
17.
Gagner M, Garcia-Ruiz A. Technical aspects of minimally invasive abdominal surgery performed with needlescopic instruments. Surg Laparosc Endosc. 1998;8(3):171–9.PubMedCrossRef
18.
d’Alessandro AA. Microthoracoscopy: at the cutting edge of thoracic surgery. J Laparoendosc Adv Surg Tech A. 1997;7(5):313–8.
19.
Yamamoto H, Kanehira A, Kawamura M, Okada M, Ohkita Y. Needlescopic surgery for palmar hyperhidrosis. J Thorac Cardiovasc Surg. 2000;120(2):276–9.PubMedCrossRef
20.
Kim H, Kim HK, Kang DY, Lee DK, Choi YH, Lim SH. A comparative study of two- versus one-lung ventilation for needlescopic bleb resection. Eur Respir J. 2011;37(5):1183–8.PubMedCrossRef
21.
Stratmann SL, McCarty TM, Kuhn JA. Radiation safety with breast sentinel node biopsy. Am J Surg. 1999;178(6):454–7.PubMedCrossRef
22.
Singer G. Occupational radiation exposure to the surgeon. J Am Acad Orthop Surg. 2005;13(1):69–76.PubMed
23.
Kim S, Kim HK, Kang DY, Jeong JM, Choi YH. Intra-operative sentinel lymph node identification using a novel receptor-binding agent (technetium-99m neomannosyl human serum albumin, 99mTc-MSA) in stage I non-small cell lung cancer. Eur J Cardiothorac Surg. 2010;37(6):1450–6.PubMedCrossRef
24.
Kim HK, Kim S, Sung HK, Lee YS, Jeong JM, Choi YH. Comparison between preoperative versus intraoperative injection of technetium-99m neomannosyl human serum albumin for sentinel lymph node identification in early stage lung cancer. Ann Surg Oncol. 2012;19(4):1343–9.PubMedCrossRef
Metadata
Title
Needlescopic Resection of Small and Superficial Pulmonary Nodule After Computed Tomographic Fluoroscopy-Guided Dual Localization with Radiotracer and Hookwire
Authors
Kyung Won Doo, MD
Hwan Seok Yong, MD, PhD
Hyun Koo Kim, MD, PhD
Sungeun Kim, MD, PhD
Eun-Young Kang, MD, PhD
Young Ho Choi, MD, PhD
Publication date
01-01-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 1/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3884-2

Other articles of this Issue 1/2015

Annals of Surgical Oncology 1/2015 Go to the issue

Endocrine Tumors

Chasing Calcitonin: Reoperations for Medullary Thyroid Carcinoma

Endocrine Tumors

Impact of 68Ga-DOTATATE PET/CT on the Surgical Management of Primary Neuroendocrine Tumors of the Pancreas or Ileum

Gastrointestinal Oncology

Proper Timing of Adjuvant Chemotherapy Affects Survival in Patients with Stage 2 and 3 Gastric Cancer

Colorectal Cancer

Diagnostic Performance of Multidetector Row Computed Tomography for Assessment of Lymph Node Metastasis in Patients with Distal Rectal Cancer

Endocrine Tumor

Retroauricular Robotic Thyroidectomy with Concomitant Neck-Lift Surgery

Endocrine Tumors

Prognostic Significance of Tumor Multifocality in Papillary Thyroid Carcinoma and its Relationship with Primary Tumor Size: A Retrospective Study of 2,309 Consecutive Patients