Wang Lijie, He Jinxian, Zhang Liang, Chen Chengcheng, Efird Jimmy T, Salvicchi Alberto, Abdelghani Ramsy, Chen Biao, Shen Weiyu
Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China.
Department of Respiration, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China.
J Thorac Dis. 2024 Dec 31;16(12):8699-8708. doi: 10.21037/jtd-24-1876. Epub 2024 Dec 28.
Video-assisted thoracoscopic surgery (VATS) is more effective for diagnosing and treating solitary pulmonary nodules (SPNs). It is sometimes difficult to localize through use of minimally invasive techniques. We evaluated the feasibility, effectiveness, and safety of a novel localization method for SPNs. Here, we describe our technical process, perioperative results, and accumulated experience over the years.
Between February 2018 and April 2023, a retrospective study of a novel claw-suture localization technique was conducted in a single center. A total of 490 patients participating in the localization of preoperative SPNs were enrolled. An anchor claw device with four hooks and three-colored sutures was used for localizing nodules under computed tomography (CT). We then evaluated the localization process and the outcomes of the operative procedure (success rate, safety, feasibility, and patient comfort).
A total of 510 SPNs were localized before surgery, and the median size of the nodules was 0.70 cm (range, 0.4-2.0 cm). Additionally, 97.1% of these nodules (495 of 510) were localized successfully without dislodgment or device fracture. Types of failures included not meeting the target value of the distance between the claw and lesion (n=12, 2.4%) and displacement of the device (n=3, 0.6%). Pneumothorax (n=63, 12.4%), parenchymal hemorrhage (n=46, 9.0%), and hemothorax (n=1, 0.2%) were the most common complications that did not require further medical treatment. Pleural reactions were reported in 2 patients (0.4%). A notable correlation was also found between the depth of the pulmonary nodules and the incidence of parenchymal hemorrhage (P<0.001). The median length for the entire process was 12 minutes (7-25 minutes). No patients reported significant pain during the localization process, and the device was retrieved with a 100% survival rate after VATS resection.
This method of claw-suture localization is safe, effective, and feasible and can be used to localize SPNs that are challenging to locate before operation.
电视辅助胸腔镜手术（VATS）在诊断和治疗孤立性肺结节（SPN）方面更有效。有时使用微创技术进行定位会很困难。我们评估了一种用于SPN的新型定位方法的可行性、有效性和安全性。在此，我们描述我们的技术过程、围手术期结果以及多年来积累的经验。
2018年2月至2023年4月，在单一中心对一种新型爪形缝线定位技术进行了回顾性研究。共纳入490例参与术前SPN定位的患者。使用带有四个钩子和三色缝线的锚定爪装置在计算机断层扫描（CT）下对结节进行定位。然后我们评估了定位过程和手术结果（成功率、安全性、可行性和患者舒适度）。
术前共定位510个SPN，结节的中位大小为0.70 cm（范围0.4 - 2.0 cm）。此外，这些结节中有97.1%（510个中的495个）成功定位，无移位或装置断裂。失败类型包括爪与病变之间的距离未达到目标值（n = 12，2.4%）和装置移位（n = 3，0.6%）。气胸（n = 63，12.4%）、实质内出血（n = 46，9.0%）和血胸（n = 1，0.2%）是最常见的并发症，无需进一步治疗。2例患者（0.4%）报告有胸膜反应。还发现肺结节深度与实质内出血发生率之间存在显著相关性（P < 0.001）。整个过程的中位时长为12分钟（7 - 25分钟）。在定位过程中没有患者报告明显疼痛，VATS切除术后装置取出成功率为100%。
这种爪形缝线定位方法安全、有效且可行，可用于定位术前难以定位的SPN。
