Preoperative Small Pulmonary Nodule Localisation Using Hookwires or Coils: Strategy Selection in Adverse Events

Objective We conducted a retrospective study of adverse events associated with the preoperative procedure of computed tomography (CT)–guided hookwire or coil localisation. We analysed the experience of and process flaws in resecting ground-glass nodules (GGNs) using video-assisted thoracoscopic surgery (VATS) and determined the remedial strategy. Methods Adverse events were evaluated in 20 patients with 25 GGNs who underwent CT-guided hookwire or coil localisation before VATS. For lesions not successfully marked or detected, palpation, resection of the highly suspected area, segmentectomy or lobectomy was performed. Results Among all adverse events, 10 were dislodgement of the marking materials, 2 were breakaway of the marking materials, 4 were >2-cm distance between the lesions and the tip, one was marking material across the two adjacent lobes, 10 were pneumothorax and two were certain parts of marking materials stuck into the walls. All GGNs were resected successfully. Fifteen lesions were detected by palpation. Three GGNs were discovered after the resection of highly suspected areas. The GGNs were removed by lobectomy. Segmentectomies and lobectomies were performed directly on two and four GGNs, respectively. Conclusions When adverse events occur, a second localisation, intraoperative localisation, resection of a highly suspected area, or a segmentectomy or lobectomy can be successfully attempted using VATS for resection of GGNs.