Novel CT-guided coil localization of peripheral pulmonary nodules prior to video-assisted thoracoscopic surgery: a pilot study

Background: Small peripheral lung nodules detected on computed tomography (CT) scans are often difficult to find during thoracoscopic resection, and the present localizing techniques are inefficient or impractical. Purpose: To evaluate a novel marking procedure for small peripheral pulmonary nodules using an embolization coil. Material and Methods: Patients with small peripheral pulmonary nodules underwent preoperative CT-guided nodule localization using an embolization coil and then resection by fluoroscopically-guided video-assisted thoracoscopic surgery (VATS; group A, n = 22), or, underwent conventional VATS without prior location procedures (group B, n = 16). Comparisons were made between group A and group B concerning operative time, hospitalization, postoperative drainage, and complications. Histopathological diagnoses were made immediately after resection of pulmonary nodules. Results: All CT-guided embolization coil fixations were successful. No patient in group A and eight (50%) in group B required conversion to open thoracotomy (P < 0.0001). No severe complications occurred in either group. Compared with group B, group A had a significantly shorter mean operative time and hospitalization, and less postoperative drainage. Conclusion: Preoperative localization of small peripheral pulmonary nodules using CT-guided embolization coil insertion and subsequent fluoroscopically-guided VATS resection is safer and more effective than conventional VATS.