Related Experiment Video
Updated: May 6, 2026
Thoracoscopic Extended Right Middle Plus Lower Sleeve Lobectomy for Non-Small-Cell Lung Cancer
Published on: February 27, 2026
Feasibility of Wedge Resection for Subpleural Hilar Lung Nodules Using CT-guided Hookwire Localization and Ultrasonic
Yang Zhang1,2,3, Molin Zhang1,2,3, Haoxuan Wu1,2,3
1Department of Thoracic Surgery and State Key Laboratory of Genetics and Development of Complex Phenotypes, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.
Objective:
To evaluate the safety and efficiency of a novel computed tomography (CT)-guided hookwire localization technique, aiming to enable parenchyma-sparing wedge resection using video-assisted thoracoscopic surgery (VATS) for small, hilar-proximal, ground-glass opacity (GGO)-dominant nodules.
Summary Background Data:
Localizing hilar-proximal GGOs remains challenging. For small, hilar-proximal, GGO-dominant lung nodules, there is no consensus regarding the optimal surgical approach.
Methods:
This was a multicenter retrospective study from January 2023 to July 2025 including 79 patients with subpleural pulmonary nodules ≤ 2 cm in diameter and consolidation-to-tumor ratio (CTR) ≤ 0.25 located near the hilum. Patients underwent preoperative CT-guided hookwire localization using transfissural or traversing-lobe approach, followed by uniportal VATS wedge resection. Resection was performed using ultrasonic dissection with limited stapler use to maximize lung preservation.
Results:
79 nodules (median, 7 mm, range 6-20 mm) were successfully localized. Minor asymptomatic pneumothorax occurred after localization in 12 patients and small pulmonary hemorrhage in 10 patients. The median operative time was 15.0 minutes (range 10-28 minutes). Histopathology confirmed 9 adenocarcinoma in situ, 53 minimally invasive adenocarcinoma, 14 invasive adenocarcinoma, and 3 benign lesions. 10 patients experienced persistent air leak > 72h and no other major complications occurred. Median postoperative hospital stay was 3 days (range 2 - 6 d). At a median follow-up of 17.3 months, no local recurrences or deaths have been detected.
Conclusions:
This novel CT-guided hookwire localization strategy proved highly effective for small, hilar-proximal, GGO-dominant lung nodules, facilitating their successful removal by VATS wedge resection with parenchyma-sparing technique.
