Comparison of CT-guided suture hook anchor and indocyanine green localization for multiple pulmonary nodules

The preoperative application of computed tomography (CT), particularly suture hook anchor (SHA) and indocyanine green (IG) injection, for guiding the localization of pulmonary nodules (PNs) is increasingly used. Nevertheless, these two approaches have not been compared in terms of safety and performance. Here, the effectiveness and safety of CT-guided SHA and IG localization for multiple PNs during video-assisted thoracoscopic surgery (VATS) were evaluated.

Consecutive cases with multiple PNs that received SHA or IG under CT guidance before VATS between January 2022 and December 2024 were retrospectively analyzed. Localization success, procedure duration, complication rates, and VATS-related outcomes analyzed.

Seventy-four cases were enrolled, of which 36 (79 nodules) underwent SHA localization, and 38 (92 nodules) underwent IG localization. All patients successfully underwent one-stage localization and subsequent VATS resection. The technical success rates for both procedures were 100%. The IG-mediated procedure was markedly shorter than SHA (10.6 ± 4.4 min vs. 23.4 ± 11.9 min, P = 0.001). The incidence of pneumothorax (27.8% vs. 36.8%, P = 0.405) and pulmonary hemorrhage (38.9% vs. 21.1%, P = 0.093) was comparable between the two procedures. VATS limited resections were technically successful in all patients (100% in both groups), with all nodules resected in a single operative session. The median operative duration was comparable between the SHA and IG groups (85 minutes vs. 80 minutes, P = 0.269).

Both SHA and IG-mediated localization under CT guidance safe and effective for the preoperative evaluation of multiple PNs. While outcomes were similar across both methods, IG localization demonstrated the advantage of significantly reduced localization time, suggesting it may be a more time-efficient option in clinical practice.