Wu Wei-Bin, Wu Yong-Hui, Zhang Kai, Li Xiao-Jun, Xu Jian-Nan, Huang Yuan-Heng, Zhang Jian, Chen Hui-Guo
Department of Cardiothoracic Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Quant Imaging Med Surg. 2025 Apr 1;15(4):2802-2812. doi: 10.21037/qims-24-1571. Epub 2025 Mar 28.
Thoracoscopic wedge resection of deep-seated small pulmonary nodules (SPNs) with an adequate surgical margin distance is a challenging yet crucial aspect of successful resection. In our previous study, we introduced a novel localization technique for SPN wedge resection with sufficient margin distance. The aim of the present study was to evaluate margin distance assessment of this localization technique for deep-seated SPNs in wedge resection by standardizing the surgical procedures.
From November 2021 to October 2023, 73 patients with deep-seated SPNs who underwent computed tomography (CT)-guided localization followed by thoracoscopic wedge resection were enrolled. A device characterized by a 4-hook claw and a tri-colored suture with a scale was utilized for localization. Clinical data were collected to evaluate the efficiency of the procedure in obtaining a sufficient margin distance for deep-seated SPN wedge resection.
A total of 73 patients were included. The median size of the nodules was 10.7 mm (range, 5-23 mm), and the median nodule depth was 25.3 mm (range, 20-49 mm). Needle localization was successful without dislodgment in 68 of the 73 patients (93.2%), and all nodules were completely wedge resected. No complications from localization required further medical intervention. The median resection margin distance was 14.4 mm (range, 4-29 mm), and the resection margin distance was more than 5 mm in 72 of the 73 cases (98.6%). A total of 62 of the 73 cases (84.9%) had a margin distance to tumor size ratio of ≥1.
This study provides preliminary evidence that CT-guided 4-hook needle with scaled suture localization for deep-seated SPNs, followed by wedge resection, is an efficient method. Furthermore, it is beneficial in obtaining adequate margin distances for wedge resection.
对深部肺小结节（SPN）进行胸腔镜楔形切除并保证足够的手术切缘距离是成功切除的一个具有挑战性但又至关重要的方面。在我们之前的研究中，我们介绍了一种用于SPN楔形切除且具有足够切缘距离的新型定位技术。本研究的目的是通过规范手术操作来评估这种定位技术在深部SPN楔形切除中切缘距离的评估情况。
2021年11月至2023年10月，纳入73例接受计算机断层扫描（CT）引导下定位并随后进行胸腔镜楔形切除的深部SPN患者。使用一种具有4个钩爪和带刻度三色缝线的装置进行定位。收集临床数据以评估该手术在获得深部SPN楔形切除足够切缘距离方面的效率。
共纳入73例患者。结节的中位大小为10.7毫米（范围5 - 23毫米），结节的中位深度为25.3毫米（范围20 - 49毫米）。73例患者中有68例（93.2%）针定位成功且未发生移位，所有结节均完整楔形切除。定位无并发症需要进一步医疗干预。中位切除切缘距离为14.4毫米（范围4 - 29毫米），73例中有72例（98.6%）切除切缘距离大于5毫米。73例中有62例（84.9%）切缘距离与肿瘤大小之比≥1。
本研究提供了初步证据，表明CT引导下带刻度缝线的4钩针定位深部SPN后进行楔形切除是一种有效的方法。此外，它有利于获得楔形切除足够的切缘距离。
