The needlescopic surgery using instruments with a diameter of 2-mm is devised to leave minimal scarring and reduce the need for postoperative analgesia. For needlescopic lung biopsy for small pulmonary nodule, accurate and convenient method for preoperative localization is necessary. The aim of this study is to evaluate the usefulness of combined mammographic hook wire anchoring and lipiodol injection for localization of small pulmonary nodules before needlescopic lung biopsy.
Thirty-one small pulmonary nodules in 24 patients (men, 16; age, 55.2±12.44 years) were localized preoperatively by using CT-guided hook wire and 0.2ml of lipiodol. A 2-mm needlescope and a 2-mm minisite endograsp were inserted at the sixth intercostal space. The site of pulmonary nodules was found by needlescopic detection of a hook wire and their resection margin was decided by lipiodol showed on the C-arm fluoroscopic monitor (Figure). A biopsy specimen was obtained using 1 or 2 endostaplers via an 11.5-mm port at the fifth intercostal space along the anterior axillary line.
The nodules had an average diameter of 6.3±3.22mm (range, 2∼16) and were located an average distance of 10.3±1.26mm (range, 0∼60) from the pleural surface. The radiologic pattern of pulmonary nodule was pure GGO in 10 cases, pure solid in 12, and mixed type in 9. CT-guided dual localization was successful in all patients without severe complication and all nodules were easy to be detected and resected successfully under needlescope. Localization and operation times were 11.9±4.89min (range, 5∼24) and 34.4±14.720min (range, 18∼75), respectively. The pathologic diagnosis was benign lesion in 22 cases and malignant lesion in 9.
CT fluoroscopic localization of small pulmonary nodules using combined mammographic hook wire anchoring and lipiodol injection makes needlescopic lung biopsy technically feasible and accurate for resection margin and pathologic confirmation of small pulmonary nodule.
Dual localization using lipiodol and hook wire makes needlescopic resection of pulmonary nodule easier.
Hyun Koo Kim, No Financial Disclosure Information; No Product/Research Disclosure Information