Precise localization of small pulmonary nodules using Pre-VATS with Xper-CT in combination with real-time fluoroscopy-guided coil: report of 15 patients

ABSTRACT: Purpose: This study aimed to evaluate the value of precise localization of nodules using pre-video-assisted thoracic surgery (VATS) Xper–CT in combination with real-time fluoroscopy-guided coil in the resection of pulmonary nodules using VATS.Materials and Methods: Precise localization of nodules using Xper-CT in combination with real-time fluoroscopy-guided coil and wedge resection using VATS were conducted on 15 patients with 17 small pulmonary nodules (diameter 0.5–1.5 cm) from April 2015 to January 2016. The value of localization was evaluated in terms of procedure time, type of coils, associated complications of localization, and VATS success rate.Results: The success rate of coil localization was found to be 100% in the primary stage (as shown by the CT scan), and the average procedure time was 30–45 min (35.6 ± 3.05 min). No deaths or major complications occurred. Minor complications included five incidents of pneumothorax (the morbidity was 29.4%, 5/17; no patient required chest tube drainage). The dislocation of coil was found in one patient. The results of pathological examination of 17 small pulmonary nodules revealed 11 primary lung cancers, 1 mesenchymal tumor, 3 nonspecific chronic inflammations, 1 hamartoma, and 1 tuberculosis. Two patients with primary lung cancer underwent lobectomy with mediastinal lymph node dissection.Conclusion: The preoperative precise localization of small pulmonary nodules using Xper-CT-guided coil is an effective and safe technique. It helps in the resection of nodules using VATS. It increases the rate of lung wedge resection with few complications and allows for proper diagnosis with a low thoracotomy conversion rate. Keywords:: CT-guided coil localization, pulmonary nodule, video-assisted thoracic surgery