A novel localization device for small pulmonary nodules in thoracoscopic wedge resection with adequate margin...

Thoracoscopic wedge resection of small pulmonary nodules (SPNs) is a common surgical procedure. Adequate surgical margin distance is challenging and key to successful resection for malignant nodules. The aim of this study was to evaluate the feasibility of a novel localization needle in wedge resection for SPNs with adequate margin distance.

A retrospective review of needle localization cases from November 2021 to August 2022 was performed, in which 58 patients who underwent modified computed tomography (CT)-guided needle localization following thoracoscopic wedge resection were enrolled. Nodules were localized by placing a novel device characterized by a 4-hook anchor and a tricolored suture with a scale. The clinical characteristics were collected to evaluate the feasibility of the procedure in obtaining a sufficient margin distance.

A total of 68 SPNs were collected, and the median size of SPNs was 10.0 mm with a median depth of 18.9 mm. Needle localization was successful in 65 nodules (95.6%), and all nodules were completely removed. The median resection margin distance was 14 mm (range, 8-26 mm). There were 62 (91.2%) SPNs with a margin distance to tumor size ratio ≥1, 38 (92.7%) SPNs with a depth <20 mm, and 24 (88.9%) SPNs with a depth ≥20 mm, respectively. Regardless of the nodule depth, the median resection margin distances were both 14 mm.

This study indicated that modified preoperative CT-guided 4-hook needle with scaled suture localization is a safe, efficient strategy for the wedge resection of SPNs via thoracoscopic surgery. Furthermore, it was considerably advantageous for obtaining adequate margins distance, especially for deep nodules.