Sonographic guidance for the localization of peripheral pulmonary nodules during thoracoscopy

OBJECTIVE. The value of sonographic guidance during video-assisted thoracoscopic surgery (VATS) was studied in 13 patients with one or more peripheral pulmonary nodules who later underwent wedge resection. SUBJECTS AND METHODS. After a review of the chest radiographs and CT scans of each patient, sonographic guidance for VATS was requested by the attending surgeon when the nodule or nodules in question were determined to be too small or too deep in the lung parenchyma from the pleural surface for location by VATS. A multifrequency (5.0-, 6.5-, or 7.5-MHz) sonographic probe was introduced through a thoracoscopic port during VATS. The nodule or nodules in question were located by intraoperative sonography or determined by inspection and confirmed by sonography before wedge resection. The size and location of each lesion and the time needed for sonographic guidance were recorded. RESULTS. Sonography revealed a peripheral pulmonary nodule in 12 of the 13 patients. Of these, it confirmed the suspected location of the pulmonary nodule in six. In the remaining six patients, the surgeon was unable to locate the nodule without the use of sonography. The additional operative time required for sonographic guidance during VATS averaged 7.5 min. However, the time commitment of radiology personnel during surgery varied and was sometimes lengthy (maximum, 150 min). CONCLUSION. Sonographic guidance during thoracoscopy helped to locate lesions and determine their size and proximity to pleural surfaces. Sonographic guidance can be done safely and can be completed expeditiously. Unlike percutaneous hookwire techniques, sonographic guidance does not require an additional invasive procedure to locate the peripheral pulmonary nodule.