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Technical diagram of the CT-guided hook wire positioning technology. (A): Hook wire equipment. (B): Hook wire should not be inserted too shallow, otherwise it is easy to pull out the hook wire when the lung collapses. (C): The hook wire should also not be inserted too deeply; otherwise the possibility of pulmonary vascular or airway damage will increase. (D), (E) and (F): Three-step approach to insert the hook wire and take out the guide needle. (D): Hook wire and guide needle should be inserted no less than 10 mm below the visceral pleural surface. (E): The insertion distance of hook wire should be 5 mm above the tip of guide wire. (F): Guide needle could be unreeved entirely.
Source publication
Background:
Video-assisted thoracic surgery (VATS) is a minimally invasive technique for the diagnosis and management of small pulmonary nodular lesions However, the identification of some lung nodules remains difficult.
Objective:
This research aimed to investigate the clinical value of preoperative computed tomography (CT)-guided hookwire loca...
Similar publications
Background
Accurate localization of pulmonary nodules is the main difficulty experienced in wedge resection. Commonly used localization methods have their own advantages and disadvantages. However, clinical work has demonstrated that intraoperative indocyanine green localization under electromagnetic navigation bronchoscopy/virtual navigation bronc...
Citations
... Common methods include preoperative CT-guided percutaneous placement of hook wires and microcoils. Nonetheless, these procedures may cause complications such as pneumothorax and active bleeding and increase the risk of displacement [12][13][14][15][16]. Other methods involve CT-guided percutaneous placement of radioactive particles or dyes such as methylene blue, but these also lead to complications and additional challenges [17]. ...
Background
To evaluate the clinical value of CT-assisted body surface localization combined with intraoperative stereotactic anatomical localization in thoracoscopic lung nodule resection.
Methods
We retrospectively collected the clinical data of 120 patients who underwent lung nodule localization and resection surgery at the Department of Thoracic Surgery, First Affiliated Hospital of Bengbu Medical College, from January 2020 to January 2022. Among them, 30 patients underwent CT-assisted body surface localization combined with intraoperative stereotactic anatomical localization, 30 patients underwent only CT-assisted body surface localization, 30 patients underwent only intraoperative stereotactic anatomical localization, and 30 patients underwent CT-guided percutaneous microcoil localization. The success rates, complication rates, and localization times of the four lung nodule localization methods were statistically analysed.
Results
The success rates of CT-assisted body surface localization combined with intraoperative stereotactic anatomical localization and CT-guided percutaneous microcoil localization were both 96.7%, which were significantly higher than the 70.0% success rate in the CT-assisted body surface localization group (P < 0.05). The complication rate in the combined group was 0%, which was significantly lower than the 60% in the microcoil localization group (P < 0.05). The localization time for the combined group was 17.73 ± 2.52 min, which was significantly less than that (27.27 ± 7.61 min) for the microcoil localization group (P < 0.05).
Conclusions
CT-assisted body surface localization combined with intraoperative stereotactic anatomical localization is a safe, painless, accurate, and reliable method for lung nodule localization.
... Researchers have developed several preoperative localization methods for pulmonary nodules [5,6], including the use of hook wires [7][8][9], microcoils [10][11][12][13], radioactive tracers [14,15], radiographic contrast agents [16], and dyes [17,18] to accurately locate the lesions during minimally invasive surgery. However, these methods have certain drawbacks. ...
Objective
To evaluate the value and challenges of CT-guided percutaneous placement of coil and indocyanine green (ICG) in the pulmonary nodule localization techniques in video-assisted thoracic surgery (VATS). Additionally, to explore a new fluorescent probe targeting lung cancers.
Methods
This study analyzed 26 patients underwent CT-guided coil placement at the edges of pulmonary nodules and received ICG injection. Intraoperative fluorescence imaging was conducted using a fluorescence thoracoscope to assist in lesion localization and resection. Given the challenges observed in clinical cases, the study designed a new molecular imaging probe, NY-FR-07 targeting folate receptor alpha (FR-α) of lung cancer. Cellular and animal experiments were conducted to validate its safety, targeting ability of FR-α, and in vivo imaging efficacy of tumors.
Results
In the VATS guided by the coils and ICG, all 26 lesions were successfully resected. However, coil displacement and ICG diffusion into the thoracic cavity occurred, leading to an expanded surgical field in nine of the cases. To overcome these challenges, a novel fluorescent probe named NY-FR-07 was successfully developed, characterized by minimal cytotoxicity and good biocompatibility. Animal experiments demonstrated that the tumor fluorescence intensity of NY-FR-07 is higher than that of lung tissue at 24 h and 72 h. In the 0.03 mg/kg dose group at 24 h, the tumor-to-lung ratio is 1.714. At 72 h, the tumor-to-lung ratio in all different dose groups exceeds 1.5.
Conclusion
The coil and ICG localization can assist the VATS of pulmonary nodules, but it still has some limitations. Additionally, the new FR-α targeted fluorescent probe NY-FR-07 demonstrates excellent biocompatibility and precise targeting capabilities, showing potential in accurately identifying the position and boundaries of lung cancer during VATS.
... simple operative procedure, and low cost. 6 However, in adult patients receiving hook-wire CT-guided localization of pulmonary nodules, mild to severe pain can be expected. 7 Furthermore, the waiting time for surgery post-localization varies significantly, and if pain control is not good, it leads to serious discomfort and anxiety in the patient. ...
... According to a literature review, there is no fixed treatment method of the distal end of the hook-wire needle. Yan et al. 6 reported a method wherein the hook wire extending outside the chest wall was bent and loosely covered with sterile gauze to isolate it. Zhang et al. 8 and Wang et al. reported a method wherein a portion of the needle outside the patient's body was trimmed at the skin level. ...
Background
Severe pain can be expected among adult patients undergoing hook‐wire CT‐guided localization of pulmonary nodules. We compared varying pain degrees between two different treatment techniques.
Methods
Data from 100 patients who underwent hook‐wire puncture localization under preoperative CT between May 2022 and October 2022 were prospectively reviewed. Using the random number table method, the patients were assigned to an observation and control group in a 1:1 ratio. In the observation group ( n = 50), the external part of the hook‐wire positioning needle was cut off; in the control group ( n = 50), the external portion of the needle was bent. Static pain scores were measured using the visual analog scale (VAS) at 30 min, 1, and 2 h post localization for patients.
Results
No significant differences were present between the two groups in terms of patient age, sex, nodule size, and nodule location. The observation group had lower VAS scores at 30 min (2.57 ± 1.38 vs. 3.51 ± 1.87 p = 0.005), 1 h (2.43 ± 1.14 vs. 3.33 ± 1.76 p = 0.003), and 2 h (2.41 ± 1.12 vs. 3.17 ± 1.74 p = 0.011) after localization. Moreover, the pain level did not gradually worsen in either group. Both groups had a 100% localization success rate. There was no statistically significant difference ( p = 0.431) in the localized complication incidences between the two groups.
Conclusions
We found both approaches for handling the hook‐wire extending outside the chest to be safe and effective. However, cutting off the hook‐wire extending outside the chest is associated with lesser pain. Moreover, pain severity does not worsen with time after localization.
... In recent years, video-assisted thoracoscopic surgery (VATS) has become the primary modality for treating SPNs by virtue of its association with minimal trauma and rapid postoperative recovery (9,10). However, in some small SPNs that are located far from the pleura, the surface lung tissue often has no specific mark, leading to difficulties in intraoperative localization and the necessity of converting to open surgery (11)(12)(13). ...
Background
The aim of this study was to investigate the safety and efficacy of computed tomography (CT)-guided hookwire localization and new CT-guided medical glue combined with methylene blue (MGMB) localization before video-assisted thoracoscopic surgery (VATS) for solitary pulmonary nodules (SPNs) and to analyze the risk factors for complications after localization.
Methods
A total of 620 patients, comprising 727 SPNs, admitted to the Department of Thoracic Surgery of the First Hospital of the University of Science and Technology of China between December 2019 and July 2022 were retrospectively studied and case-control analyzed. According to the localization method, 620 patients were divided into the hookwire group (n=310) and MGMB group (n=310). The localization time, localization-to-surgery interval, operative time, length of hospitalization, and complication rate were compared between the 2 groups. Logistic regression was used to analyze the risk factors for the occurrence of complications in each group of localization methods.
Results
Compared to the hookwire group, the MGMB group had a shorter localization time (8.59±3.69 vs. 7.35±2.99 min; P<0.001), shorter hospital stay (5.60±2.13 vs. 6.73±2.86 days; P<0.001), and shorter operative time (103.48±54.11 vs. 98.59±49.92 min; P=0.33). The preoperative localization success rate was 99.4% (355/357) and 100% (370/370) in the hookwire group and MGMB group, respectively. No death or serious complications occurred during the localization process, but the overall complication rate was lower in the MGMB group (69/310, 22.3%) than in the hookwire group (105/310, 33.9%) (P<0.001). Logistic regression analysis showed that age, number of nodules, and localization time were risk factors for total complications, while localization technique was a protective factor for total complications [odds ratio =0.590; 95% confidence interval (CI): 0.405–0.860; P<0.05].
Conclusions
Both techniques could effectively locate SPNs before VATS; however, MGMB localization was found to be associated with a lower complication rate, shorter localization time, better safety, and higher potential clinical value and is thus worthy of clinical promotion.
... To date, the optimal localization method has not been identified, but the most commonly used methods are the microcoil, hook wire, and MB localization. Previous studies have shown that all three methods have a high success rate (>90%), [9][10][11] but the prevalence of adverse events in patients with SPNs who undergo hook wire localization can be as high as 90%. In contrast, the MB and spring microcoil methods are associated with significantly lower incidences of complications, including pneumothorax, pleural bleeding, and pleural fluid leakage, during SPN resection (13%-55%). ...
Objective:
Methylene blue (MB) and spring microcoils are used for the preoperative localization of small pulmonary nodules (SPNs). We aimed to compare the efficacy and safety of these methods using published data.
Methods:
We identified randomized controlled trials and observational studies that assessed preoperative SPN localization using MB or spring microcoil and compared these using a meta-analysis.
Results:
Seven studies of 933 patients were identified, in whom 1081 SPNs were located. Four hundred twenty-four SPNs were located using MB (n = 359 participants), and 657 SPNs were located using the spring microcoil method (n = 574 participants). The prevalence of technical success of SPN localization was higher using MB (mean deviation [MD]: 0.43; 95% confidence interval [CI]: 0.20, 0.93); the incidence of postoperative complications was lower (MD: 1.70; 95% CI: 1.09, 2.65); and the time taken for removal was longer (MD: -12.37; 95% CI: -22.60, -2.13). There were no differences with respect to the successful wedge resection rate, the time taken for localization, the duration of the procedure, or the mean hospital stay.
Conclusions:
Both methods can detect SPNs; however, MB is associated with a higher success rate and fewer postoperative complications, while spring microcoil localization is associated with more rapid removal.
... In our study, we have shown that the hookwire technique was associated with 3.6 times the risk of post-procedure pneumothorax as the methylene blue technique. In congruence with other reports, multiple puncture sites (due to multiple nodules) were among the most contributing factors to the development of pneumothorax in our patient cohort [22]. On the other hand, the use of the methylene blue technique was shown to simultaneously localize multiple nodules while yielding less risk of developing pneumothorax in other studies [23]. ...
... As regards hemoptysis, seven patients in the hookwire group in our study experienced hemoptysis versus none from the methylene blue group. Although the sample size of patients with post-procedure hemoptysis were too small to predict a causal relationship between the hookwire technique and the development of hemoptysis, the association between the hookwire technique and the post-operative bleeding has been shown in previous studies [17,20,22]. Our inclusion criteria specified participants with a normal general condition and coagulation profile who exhibited no additional lung pathologies, and therefore, there was no reason for us to believe that the cause of hemoptysis in our patient cohort was due to a preoperative condition. ...
Background
Direct localization of small and deep pulmonary nodules before thoracoscopic surgery using the hookwire or methylene blue techniques has been recently attempted for better surgical outcomes. In this study, we compare the outcomes of the above two techniques.
Methods
Two hundred and nineteen patients undergoing 135 hookwire and 151 methylene blue techniques in our University Hospital between July 2020 and January 2022 were compared for localization and hospitalization durations, and the complication risk. Other confounders included patients’ age, gender, localization position, nodules location, count, diameter, and depth.
Results
After adjustment of all predictors, the methylene blue technique was associated with a significant 0.6-min (parameter estimate (PE) = −0.568, p value = 0.0173) and an 0.7-day shorter localization and hospitalization time (PE = −0.713, p value = < 0.0001) as compared to using the hookwire technique. The hookwire technique was significantly associated with 5 times the risk of developing a post-localization complication (Adjusted Odds Ratio (Adj OR) = 4.52, 95% CI 1.53–13.33) and 3.6 times the risk of developing a pneumothorax (Adj OR = 3.57, 95% CI 1.1–11.62) as compared to adopting the methylene blue technique.
Conclusions
Compared to the hook wire technique, the methylene blue technique offers a shorter procedure and hospitalization stay, as well as a safer post-operative experience.
... Various positioning methods can be used, such as preoperative CT-guided hookwire positioning and coil positioning as well as lipiodol positioning, electromagnetic navigation bronchoscopeguided positioning, and intraoperative ultrasound-assisted positioning. The success rate of these positioning methods is 89.6% to 100% (21)(22)(23)(24)(25)(26). However, these methods have their own advantages and disadvantages. ...
Background:
Various methods exist for locating lung nodules, each with its own advantages and disadvantages. Aiming to find a more accurate, safe, effective, economical and practical method for locating lung nodules, this study evaluated the safety and feasibility of a precise three-dimensional (3D) method for positioning small pulmonary nodules based on anatomical landmarks.
Methods:
From June 2019 to December 2021, 120 patients with 131 pulmonary nodules who underwent video-assisted thoracoscopic surgery at the University of Hong Kong-Shenzhen Hospital were included in the study. Surgical data such as the positioning time, accuracy rate, pathological result, localization-related complication rate and length of postoperative hospital stay were retrospectively reviewed and analyzed. During surgery, pulmonary nodules were accurately located by the 3D positioning method based on anatomical landmarks and then removed to determine the pathology.
Results:
A total of 120 patients, including 35 males and 85 females, were included, and the median age was 53 years [interquartile range (IQR), 41-63 years]. No mortality or major morbidity occurred within 30 days. The median localization time was 11 minutes (IQR, 8-14 minutes). The accuracy of localization was 98.5%. The median diameter of the pulmonary nodules was 8 mm (IQR, 7-13 mm), and the median distance from the visceral pleura was 6 mm (IQR, 2-10 mm). No location-related complications occurred. The median length of postoperative hospital stay was 5 days (IQR, 3-7 days).
Conclusions:
The proposed positioning method is accurate, safe and feasible for selected patients with pulmonary nodules. Compared with other preoperative and intraoperative positioning methods, it can significantly reduce localization-related complications.
Background:
Early postoperative activity, an important part of enhanced recovery after surgery (ERAS) in clinical practice, is considered to be a significant component of postoperative quality care.
Objective:
To evaluate the effect of a standardized early activity program on ERAS in patients after surgery for pulmonary nodules.
Methods:
A total of 100 patients with pulmonary nodules who underwent a single-port thoracoscopic segmental resection or a wedge resection of the lung were selected for the present study. These patients were divided into a control group (n= 50) and an intervention group (n= 50) by a digital random method. The patients in the control group received routine perioperative nursing intervention for thoracic surgery due to lung cancer, and those in the intervention group received an intervention using a standardized early activity program along with routine nursing care. The evaluation indexes in both groups included postoperative indwelling time of the closed chest drainage tube, the time to the first off-bed activity after surgery, the incidence of postoperative pulmonary complications, the length of postoperative hospital stay, and patient satisfaction.
Results:
The postoperative indwelling time of the closed chest drainage tube and the time to the first off-bed activity in the intervention group were less than in the control group. The length of the postoperative hospital stay in the intervention group was shorter than in the control group, and the patient satisfaction in the intervention group was higher than in the control group. The difference for these evaluation indexes were statistically significant (P< 0.05). The number of cases of postoperative complications was four and eight in the intervention group and the control group, respectively, and the difference was not statistically significant (P> 0.05).
Conclusion:
A standardized early activity program is a safe and effective nursing measure for ERAS for patients after surgery for pulmonary nodules, which can promote earlier off-bed activity, shorten the postoperative indwelling time of the closed chest drainage tube, shorten the postoperative hospital stay, improve patient satisfaction, and promote rapid recovery.
