The main question related to the thoracoscopic resection of lung nodules is the difficulty in locating the target nodule.

The main question related to the thoracoscopic resection of lung nodules is the difficulty in locating the target nodule. Among the several [i]modus operandi[/i]s proposed, one of the mostly efficient is the preoperative placement of a localization wire into the nodule while it is in a less degree than computed tomography scan control. After our initial series of 22 thoracoscopic resections of lung nodules without preoperative localization, we have used the hook-wire technique in 21 patients. In our initial series, we had four failures while we have had barely one in the hook-wire series. simply two minor complications related to the wire localization technique occurred: a poorly tolerated pneumothorax and an intrapulmonary hemorrhage. There was no postoperative complication. The mean duration of postoperative stay was 1 to 6 days. We judge that the preopertive localization of lung nodules using a reaping-hook wire is a safe and accurate order before thoracoscopic resection in pitch uponed patients.

It is now known that the thoracoscopic approach is well suited for lung nodules, provided that they are not too large and not too entirely located.[1] This technique has indisputable advantages as it is as a decrease in postoperative pain and hospitalization stay.[2] united of the limitations of the classification however, lies in the difficulty to locate the target nodule to be ascribed to the lack of digital palpation. The main matters for the surgeon are to localize the nodule with accuracy and to resect it with a sufficient margin, as in explain surgery. Several methods have been propos to explain this problem, such as instrumental probing, addition of a mini-incision to palpate the nodule, percutaneous placement of a needle[3] percutaneous injection of methylene amethystine in the lesion,[4] and endoscopic ultrasound.[5] We report our initial experience with the percutaneous hook-wire technique.

PATIENTS AND METHODS

We have made 42 attempts at thoracoscopic lung nodule resections in 42 patients. In all on the other hand two cases, no preoperative diagnosis was available. These sum of two units patients had a diagnosis of primary lung cancer unless were selected for wedge resections because of impaired lung function. Twelve gone out of the 42 patients had a history of primary malignancy. The nodule was solitary in 34 cases and multiple in 8 cases. Among the eight patients with multiple nodules, the aim of the thoracoscopy was curative in barely one case and diagnostic in the remaining the sames Indeed, the lack of accuracy of the thoracoscopic approach to be paid to the absence of digital palpation l us to choose open resection in case a curative resection of multiple nodules is necessary. The last 21 patients were operated upon after percutaneous placement of a sickle wire in the tumor in subordination to computed tomography scan control. In these 21 patients, 22 nodules were rareed for resection after percutaneous localization. They were located in the right upper lobe (n = 9) right lower lobe (n = 5) left upper lobe (n = 6) and left lower lobe (n = 2) The nodules ranged in size from 4 mm to 20 mm with an average diameter of 12 mm

Technique

All patients referr for preoperative needle localization of a pulmonary nodule had initially undergone diagnostic CT examination of the thorax with 10-mm section collimation. The original diagnostic CT reflection was reviewed by the surgeon and the radiologist to prefer a peripheral nodule suitable for percutaneous needle localization and thoracoscopic resection. All localization managements were performed with a CT scanner (Elite Plus, Elscint). The patient was placed onward the CT table in a position (supine or tending depending on nodule location) that allowed the shortest possible direct access way for needle placement, but the planned passage in the parenchyma must be longer than 1 cm to allow the snareed wire to unfold. To confirm the location of the nodule, several preliminary contiguous CT images with 10-mm section collimation were obtained while the patient's lung was at satiated inspiration. In the cases in which the nodule was localized immediately below an overlying rib, the gantry was tilted in the same manner that the nodule would be positioned an interspace away from the overlying rib. The transverse of the same height and exact site of the needle's insertion were determined by dint of radiopaque grid placed on the patient's skin. The skin was disinfected with providone-iodine solution and sterilely draped. A 1 percent lidocaine solution was used for local anesthesia. The needle used to administer the local anesthetic was left in place, and additional images were obtained to confirm the planned course of the localization needle. A mammofix breast localization hypothesis (Nycomed Ingenor, Paris France or Manan Medical harvests Northbrook, Ill) was used for nodule localization with a 20-gauge localization needle and a bent holdered localization wire of 30-cm long duration As this 20-gauge needle has no inner stiletto we preferred to use a 19-gauge needle (Greene DGBS-100 color Bjaeverskov, Denmark). During suspended replete inspiration, the needle (Greene) was inserted into the lung along the planned way using a CT guidance laser scheme The needle was positioned to within 1 cm of the nodule, as confirmed with additional CT images. The stiletto was then removed from the exterior 19-gauge needle and the traped wire was introduced through the needle The needle was then remov and the wire was left in the lung following CT images were obtained after the course to confirm the position of the localization wire relative to the nodule. A dressing was then applied to the skin hall site of the localization wire. The CT localization performance itself took about 30 min to consummated (40 min in the patient with pair localization wires); this time does not include transport and waiting.

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