Clinical value and application of preoperative CT-guided hookwire localization of solitary pulmonary nodules for video-assisted thoracic surgery

Clinical application of CT-assisted body surface localization combined with intraoperative stereotactic anatomical localization in thoracoscopic lung nodule resection: a single-centre retrospective study

BACKGROUND

Today, the detection rate of lung nodules is increasing. Some of these nodules may become malignant. Thus, timely resection of potentially malignant nodules is essential. However, Identifying the location of nonsurface or soft-textured nodules during surgery is challenging. Various localization techniques have been developed to accurately identify lung nodules. Common methods include preoperative CT-guided percutaneous placement of hook wires and microcoils. Nonetheless, these procedures may cause complications such as pneumothorax and haemothorax. Other methods regarding localization of pulmonary nodules have their own drawbacks. We conducted a clinical study which was retrospective to identify a safe, accurate and suitable method for determining lung nodule localization. To evaluate the clinical value of CT-assisted body surface localization combined with intraoperative stereotactic anatomical localization in thoracoscopic lung nodule resection.

METHODS

We retrospectively collected the clinical data of 120 patients who underwent lung nodule localization and resection surgery at the Department of Thoracic Surgery, First Affiliated Hospital of Bengbu Medical College, from January 2020 to January 2022. Among them, 30 patients underwent CT-assisted body surface localization combined with intraoperative stereotactic anatomical localization, 30 patients underwent only CT-assisted body surface localization, 30 patients underwent only intraoperative stereotactic anatomical localization, and 30 patients underwent CT-guided percutaneous microcoil localization. The success rates, complication rates, and localization times of the four lung nodule localization methods were statistically analysed.

RESULTS

The success rates of CT-assisted body surface localization combined with intraoperative stereotactic anatomical localization and CT-guided percutaneous microcoil localization were both 96.7%, which were significantly higher than the 70.0% success rate in the CT-assisted body surface localization group (P < 0.05). The complication rate in the combined group was 0%, which was significantly lower than the 60% in the microcoil localization group (P < 0.05). The localization time for the combined group was 17.73 ± 2.52 min, which was significantly less than that (27.27 ± 7.61 min) for the microcoil localization group (P < 0.05).

CONCLUSIONS

CT-assisted body surface localization combined with intraoperative stereotactic anatomical localization is a safe, painless, accurate, and reliable method for lung nodule localization.

Evaluation of pain levels treated by the distal end of the hook-wire positioning needle: A randomized controlled study

BACKGROUND

Severe pain can be expected among adult patients undergoing hook-wire CT-guided localization of pulmonary nodules. We compared varying pain degrees between two different treatment techniques.

METHODS

Data from 100 patients who underwent hook-wire puncture localization under preoperative CT between May 2022 and October 2022 were prospectively reviewed. Using the random number table method, the patients were assigned to an observation and control group in a 1:1 ratio. In the observation group (n = 50), the external part of the hook-wire positioning needle was cut off; in the control group (n = 50), the external portion of the needle was bent. Static pain scores were measured using the visual analog scale (VAS) at 30 min, 1, and 2 h post localization for patients.

RESULTS

No significant differences were present between the two groups in terms of patient age, sex, nodule size, and nodule location. The observation group had lower VAS scores at 30 min (2.57 ± 1.38 vs. 3.51 ± 1.87 p = 0.005), 1 h (2.43 ± 1.14 vs. 3.33 ± 1.76 p = 0.003), and 2 h (2.41 ± 1.12 vs. 3.17 ± 1.74 p = 0.011) after localization. Moreover, the pain level did not gradually worsen in either group. Both groups had a 100% localization success rate. There was no statistically significant difference (p = 0.431) in the localized complication incidences between the two groups.

CONCLUSIONS

We found both approaches for handling the hook-wire extending outside the chest to be safe and effective. However, cutting off the hook-wire extending outside the chest is associated with lesser pain. Moreover, pain severity does not worsen with time after localization.

Computed tomography-guided hookwire localization and medical glue combined with methylene blue localization for pulmonary nodules before video-assisted thoracoscopic surgery: a single-center, retrospective study

Background

The aim of this study was to investigate the safety and efficacy of computed tomography (CT)-guided hookwire localization and new CT-guided medical glue combined with methylene blue (MGMB) localization before video-assisted thoracoscopic surgery (VATS) for solitary pulmonary nodules (SPNs) and to analyze the risk factors for complications after localization.

Methods

A total of 620 patients, comprising 727 SPNs, admitted to the Department of Thoracic Surgery of the First Hospital of the University of Science and Technology of China between December 2019 and July 2022 were retrospectively studied and case-control analyzed. According to the localization method, 620 patients were divided into the hookwire group (n=310) and MGMB group (n=310). The localization time, localization-to-surgery interval, operative time, length of hospitalization, and complication rate were compared between the 2 groups. Logistic regression was used to analyze the risk factors for the occurrence of complications in each group of localization methods.

Results

Compared to the hookwire group, the MGMB group had a shorter localization time (8.59±3.69 vs. 7.35±2.99 min; P<0.001), shorter hospital stay (5.60±2.13 vs. 6.73±2.86 days; P<0.001), and shorter operative time (103.48±54.11 vs. 98.59±49.92 min; P=0.33). The preoperative localization success rate was 99.4% (355/357) and 100% (370/370) in the hookwire group and MGMB group, respectively. No death or serious complications occurred during the localization process, but the overall complication rate was lower in the MGMB group (69/310, 22.3%) than in the hookwire group (105/310, 33.9%) (P<0.001). Logistic regression analysis showed that age, number of nodules, and localization time were risk factors for total complications, while localization technique was a protective factor for total complications [odds ratio =0.590; 95% confidence interval (CI): 0.405-0.860; P<0.05].

Conclusions

Both techniques could effectively locate SPNs before VATS; however, MGMB localization was found to be associated with a lower complication rate, shorter localization time, better safety, and higher potential clinical value and is thus worthy of clinical promotion.

Use of methylene blue and a spring microcoil in the preoperative localization of small pulmonary nodules under CT guidance: a meta-analysis

OBJECTIVE

Methylene blue (MB) and spring microcoils are used for the preoperative localization of small pulmonary nodules (SPNs). We aimed to compare the efficacy and safety of these methods using published data.

METHODS

We identified randomized controlled trials and observational studies that assessed preoperative SPN localization using MB or spring microcoil and compared these using a meta-analysis.

RESULTS

Seven studies of 933 patients were identified, in whom 1081 SPNs were located. Four hundred twenty-four SPNs were located using MB (n = 359 participants), and 657 SPNs were located using the spring microcoil method (n = 574 participants). The prevalence of technical success of SPN localization was higher using MB (mean deviation [MD]: 0.43; 95% confidence interval [CI]: 0.20, 0.93); the incidence of postoperative complications was lower (MD: 1.70; 95% CI: 1.09, 2.65); and the time taken for removal was longer (MD: -12.37; 95% CI: -22.60, -2.13). There were no differences with respect to the successful wedge resection rate, the time taken for localization, the duration of the procedure, or the mean hospital stay.

CONCLUSIONS

Both methods can detect SPNs; however, MB is associated with a higher success rate and fewer postoperative complications, while spring microcoil localization is associated with more rapid removal.

Application of a standardized early activity program on enhanced recovery after surgery in patients after surgery for pulmonary nodules

BACKGROUND

Early postoperative activity, an important part of enhanced recovery after surgery (ERAS) in clinical practice, is considered to be a significant component of postoperative quality care.

OBJECTIVE

To evaluate the effect of a standardized early activity program on ERAS in patients after surgery for pulmonary nodules.

METHODS

A total of 100 patients with pulmonary nodules who underwent a single-port thoracoscopic segmental resection or a wedge resection of the lung were selected for the present study. These patients were divided into a control group (n= 50) and an intervention group (n= 50) by a digital random method. The patients in the control group received routine perioperative nursing intervention for thoracic surgery due to lung cancer, and those in the intervention group received an intervention using a standardized early activity program along with routine nursing care. The evaluation indexes in both groups included postoperative indwelling time of the closed chest drainage tube, the time to the first off-bed activity after surgery, the incidence of postoperative pulmonary complications, the length of postoperative hospital stay, and patient satisfaction.

RESULTS

The postoperative indwelling time of the closed chest drainage tube and the time to the first off-bed activity in the intervention group were less than in the control group. The length of the postoperative hospital stay in the intervention group was shorter than in the control group, and the patient satisfaction in the intervention group was higher than in the control group. The difference for these evaluation indexes were statistically significant (P< 0.05). The number of cases of postoperative complications was four and eight in the intervention group and the control group, respectively, and the difference was not statistically significant (P> 0.05).

CONCLUSION

A standardized early activity program is a safe and effective nursing measure for ERAS for patients after surgery for pulmonary nodules, which can promote earlier off-bed activity, shorten the postoperative indwelling time of the closed chest drainage tube, shorten the postoperative hospital stay, improve patient satisfaction, and promote rapid recovery.

Comparative study of the effect of preoperative hookwire and methylene blue localization techniques on post-operative hospital stay and complications in thoracoscopic pulmonary nodule surgery

BACKGROUND

Direct localization of small and deep pulmonary nodules before thoracoscopic surgery using the hookwire or methylene blue techniques has been recently attempted for better surgical outcomes. In this study, we compare the outcomes of the above two techniques.

METHODS

Two hundred and nineteen patients undergoing 135 hookwire and 151 methylene blue techniques in our University Hospital between July 2020 and January 2022 were compared for localization and hospitalization durations, and the complication risk. Other confounders included patients' age, gender, localization position, nodules location, count, diameter, and depth.

RESULTS

After adjustment of all predictors, the methylene blue technique was associated with a significant 0.6-min (parameter estimate (PE) = -0.568, p value = 0.0173) and an 0.7-day shorter localization and hospitalization time (PE = -0.713, p value =  < 0.0001) as compared to using the hookwire technique. The hookwire technique was significantly associated with 5 times the risk of developing a post-localization complication (Adjusted Odds Ratio (Adj OR) = 4.52, 95% CI 1.53-13.33) and 3.6 times the risk of developing a pneumothorax (Adj OR = 3.57, 95% CI 1.1-11.62) as compared to adopting the methylene blue technique.

CONCLUSIONS

Compared to the hook wire technique, the methylene blue technique offers a shorter procedure and hospitalization stay, as well as a safer post-operative experience.