CT-guided microcoil versus hook-wire localization of pulmonary nodule prior to video-assisted thoracoscopic surgery without fluoroscopic guidance

BackgroundBoth microcoils and hook-wires are commonly utilized for preoperative pulmonary nodule localization due to their convenience, but it remains unclear which one should be prioritized for recommendation.AimsTo compare the safety and efficacy of microcoils and hook-wires for pulmonary nodule localization.MethodsFrom January 2021 to December 2021, 310 consecutive patients (113 males and 197 females) with 341 pulmonary nodules who underwent CT-guided microcoil or hook-wire localization prior to video-assisted thoracoscopic surgery (VATS) at our center were retrospectively included in this study. There were 161 patients in the microcoil group and 149 patients in the hook-wire group. The successful localization rate, complication rate, radiation exposure, and medical costs were compared between the two groups.ResultsA total of 341 pulmonary nodules were localized, with a success rate of 99% (180/184) in the microcoil group and 93% (146/157) in the hook-wire group, respectively. All patients successfully underwent VATS. Multivariate analysis revealed that hook-wire localization, shorter needle depth into the lung tissue and the longer waiting time from localization to VATS were the risk factors for the localization failure. The incidences of pneumothorax in the microcoil group and hook-wire group were 34.8% (56/161) and 34.9% (52/149), respectively (P = 0.983). The incidences of pneumorrhagia were 13% (24/184) and 46.5% (73/157), respectively (P = 0.000). Multivariate analysis revealed that hook-wire localization and greater depth of needle penetration into lung tissue were risk factors for pneumorrhagia.ConclusionMicrocoil localization of pulmonary nodules is superior to hook-wire localization in terms of efficacy and safety. This finding provides insight into priority and broader promotion of microcoil localization. CT-guided localization of pulmonary nodules can improve the success rate of video-assisted thoracoscopic pulmonary wedge resection. CT-guided microcoil or hook-wire localization of pulmonary nodules prior to video-assisted thoracoscopic surgery is a well-established technique with a high success rate and a low incidence of major complications. Due to their material properties, microcoils are more stable than hook-wires in terms of localization, allowing for longer waiting periods for surgery after localization without dislodgment, with a lower risk of pulmonary bleeding, and a better patient experience.