Intracorporeal direct measurement for localizing peripheral pulmonary nodules during thoracoscopy

Localizing small lung nodules during thoracoscopy is challenging for thoracic surgeons. In this case series, a novel technique for intraoperative localization that combines preoperative computed tomography (CT) with direct measurement during thoracoscopy is described.

A preoperative CT within two months before surgery was mandatory for precise planning of the resection area. During thoracoscopy, intracorporeal direct measurement (ICDM) for intraoperative localization was undergone if the targeted nodule was non-palpable and non-visualized. According to the location of the targeted nodule, longitudinal, and horizontal landmarks were chosen. The distances between the nodule and these landmarks were obtained from both CT images and intraoperative measurements during thoracoscopy. Based on the measurements, the x-axis and y-axis coordinates of the nodule were calculated and marked on the visceral pleura. A thoracoscopic wedge resection with an adequate margin was performed. From July 2014 to December 2018, ICDM was applied in 27 patients with peripheral pulmonary nodules smaller than 2 cm. Their medical records were reviewed retrospectively to evaluate the feasibility and safety of this technique.

Twenty-six of the twenty-seven nodules were successfully identified (96.3%). The nodules included 13 primary lung cancers, 5 metastases, and 9 benign lesions. The median nodule size was 7 mm (range, 4-17 mm), and the median distance of the nodule from the visceral pleura was 8.1 mm (range, 1.0-31.2 mm). The median localization time was 24 minutes (range, 8-109 mm). Two patients (7.4%) had a prolonged air leak, but there was no procedure-related mortality.

ICDM is an effective and safe method for localizing peripheral lung nodules during thoracoscopy.