Uniportal video-assisted thoracic surgery resection of subsolid or millimetric nodules using an innovative micro-coil...

Sometimes, the identification of ground-glass opacities (GGOs), small or deep pulmonary nodules can be difficult also in expert hands. Usually for these lesions pulmonary lobectomy is an overtreatment, so we developed a technique to identify easily these nodules. The objective of this research is to assess the effectiveness and safety of using preoperative cone beam computed tomography (CBCT) to guide the placement of micro-coils in the lung parenchyma near GGO and small lesions. Additionally, the study aims to identify potential factors that could predict coil-assisted failures during uniportal video-assisted thoracic surgery (U-VATS) resections.

The clinical, radiological, and surgical records of 117 patients who underwent U-VATS resection following CBCT-guided micro-coil localization of GGOs and small deep nodules between January 2017 and February 2023 were retrospectively analyzed. We have placed a micro coil under CBCT guide before the intervention in the 24 hours preceding the intervention. The patient received a pulmonary wedge resection in U-VATS technique and an immediate fresh frozen section to determine the necessity of a pulmonary lobectomy.

One hundred and eight lesions/117 lesions (92.3%) were correctly identified by the coil. The coil placement had only mild complications: perilesional bleeding, pneumothorax requiring pleural drainage (2/117), hypotension (2/117), subcutaneous emphysema (1/117) and 1 case of coil retained in the chest wall. Ninety-seven lesions/117 lesions (82.9%) were malignant. Among these, 74 (76.3%) were lung adenocarcinomas.

Preoperative CBCT-guided micro-coil localization, is a safe and cheap procedure, allows the detection of GGOs, small or deep nodules in U-VATS with low rate of conversion to thoracotomy and few complications, without any use of intraoperatory radiations.