Video-assisted thoracoscopic surgical wedge resection using multiplanar computed tomography reconstruction-fluoroscopy after CT guided microcoil localization.

Background: When early-stage lung cancer is diagnosed, the recommended treatment is anatomical resection using video-assisted thoracoscopic surgery (VATS) or robotic lobectomy. However, nonanatomical resection, known as wedge resection (WR), which is performed to diagnose pulmonary nodules, can be problematic for clinicians performing VATS or robotic-assisted thoracic surgery (RATS). The purpose of this study was to evaluate the safety and effectiveness of VATS WR using multiplanar computed tomography reconstruction (CT MPR)-fluoroscopy after CT guided microcoil localization to achieve complete pulmonary nodule resection.

Methods: Between January 2016 to December 2020, the medical records of patients who underwent CT-guided microcoil localization for suspicious malignant pulmonary nodules and VATS WR with CT MPR and intraoperative fluoroscopy were retrospectively reviewed.

Results: All 130 patients successfully underwent CT-guided localization. The success rate of VATS WR with CT MPR-intraoperative fluoroscopy was 98.5%. Mean operation time was 58 min (range 50-84 min). The postoperative complication rate was 3.1%, and no major postoperative complications were reported. The mean postoperative length of hospital stay was 4.7 days (range 4-8 days).

Conclusions: VATS WR using CT MPR-fluoroscopy after CT guided microcoil localization is a safe and highly effective approach for complete pulmonary nodule resection. However, even in uniport VATS or recently performed robotic surgery, localization and resection of nonvisible, nonpalpable pulmonary nodules is a challenging problem. Consequently, satisfactory outcomes can be expected if this technique is used for suspicious malignant pulmonary nodule resection.