CT-guided coaxial four-hook localization improves precision and efficiency in video-assisted thoracoscopic surgery: a...

With the increasing detection of small and indeterminate pulmonary nodules in the era of low-dose computed tomography (CT) screening, accurate preoperative localization has become critical for successful video-assisted thoracoscopic surgery (VATS), particularly for non-palpable lesions. This study aimed to evaluate and compare the effectiveness and complication profiles of 3D image reconstruction and a novel CT-guided coaxial four-hook localization system.

This retrospective study included patients who underwent VATS for pulmonary nodules, guided by either 3D image reconstruction (n=273 nodules) or CT-guided coaxial four-hook localization (n=255 nodules). Clinical and imaging variables were compared, including nodule characteristics, surgical approach, operative time, hospital stay, and complication rates. Multivariate logistic regression was performed to identify independent risk factors for procedure-related complications.

Both the 3D image reconstruction group and CT-guided localization group achieved high localization success rates (98.5% vs. 99.6%). Compared to the 3D image reconstruction group, patients in the CT-guided localization group had significantly smaller nodules, a higher proportion of pure ground-glass nodules, and shorter pleural distances (all P<0.001). In subgroups with benign lesions, adenocarcinoma in situ, and minimally invasive adenocarcinoma, the CT-guided localization group showed a higher rate of wedge resections and significantly shorter operative times (all P<0.05). Although the CT-guided localization group exhibited a higher overall complication rate, primarily pneumothorax, most events were mild and self-limited. Multivariate analysis identified greater needle depth as an independent risk factor for pulmonary hemorrhage in the CT-guided localization group (P<0.01).

Both 3D image reconstruction and CT-guided localization are safe and effective for preoperative guidance in VATS. The CT-guided method provides superior intraoperative precision and efficiency, particularly in managing small, pure ground-glass nodules and in cases requiring function-preserving wedge resections.