The application of CT-free electromagnetic navigation-guided percutaneous puncture localization of pulmonary nodules

The accurate localization of small pulmonary nodules remains a significant challenge in thoracic surgery, particularly for lesions that are invisible, impalpable. This study aimed to evaluate the feasibility and safety of a novel CT-free electromagnetic navigation-guided percutaneous puncture (ENPP) technique for intraoperative localization of pulmonary nodules.

A single-arm, prospective clinical study was conducted at our hospital, between July and December 2024. Patients with pulmonary nodules ≤ 20 mm who were scheduled for thoracoscopic wedge resection were enrolled. Preoperatively, a computed tomography scan was performed to acquire imaging data for three-dimensional trajectory planning using an electromagnetic navigation system. After induction of general anesthesia in the operating room, percutaneous puncture localization was performed under real-time electromagnetic tracking guidance, followed by immediate thoracoscopic wedge resection. Localization success rate, localization accuracy, procedure time, complications and pathological outcomes were analyzed.

A total of 31 patients (mean age: 53.3 ± 12.7 years; 51.6% male) were enrolled. One-time puncture success rate was 100% (31/31), and overall localization success rate was 93.5% (29/31). The mean puncture time was 2.5 ± 0.5 min. The mean nodule size was 0.85 ± 0.26 cm, with a mean distance of 1.00 ± 0.40 cm from the pleura. The mean distance between the needle tip and the nodule was 0.51 ± 0.50 cm. All patients underwent successful uniportal thoracoscopic wedge resection with R0. No major complications such as pneumothorax, hemorrhage, or air embolism occurred.

CT-free ENPP is a safe and workflow-efficient localization technique for small peripheral pulmonary nodules. This technique minimizes radiation exposure, reduces patient discomfort, and enhances intraoperative efficiency.