title: Percutaneous fiducial localization for thoracoscopic wedge resection of small pulmonary nodules.
abstract: BACKGROUND
  The advent of high-resolution computed tomography scanning and increase in use of chest imaging for high-risk patients has led to an increase in the identification of small pulmonary nodules. The ability to locate and remove these nodules through a thoracoscopic approach is difficult. The purpose of this study is to report our experience with fiducial localization and percutaneous thoracoscopic wedge resection of small pulmonary nodules.
  
  
  METHODS
  This is a retrospective analysis of our patients who underwent computed tomography-guided fiducial localization of pulmonary nodules. Nodules were identified with intraoperative fluoroscopy and removed by thoracoscopic wedge resection.
  
  
  RESULTS
  Sixty-five nodules were removed in 58 patients. Removal was successful in 98% of patients (57 of 58); 79% of the nodules (53 of 65) were cancers; 20% of these were primary lung cancers of which 9 were pure ground-glass opacities. Mean size of the nodules was 9.9 ± 4.6 mm (range, 3 to 24 mm). Mean depth from visceral pleural surface was 18.7 ± 12 mm (range, 2 to 35 mm). Mean procedure time was 58.7 ± 20.1 minutes (range, 30 to 120), and mean length of stay was 2 days (range, 1 to 6). Complications occurred in 3 patients and included fiducial embolization, fiducial migration, and parenchymal hematoma.
  
  
  CONCLUSIONS
  Fiducial localization facilitates identification and removal of small pulmonary nodules and alleviates the need for direct nodule palpation. As shown by our series, thoracoscopic wedge resection with fiducial localization is an accurate and efficient technique. This method provides a standardized means by which to resect small and deep pulmonary nodules or ground-glass opacities.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Emory University, Emory University Hospital, Atlanta, Georgia. Electronic address: msanch2@emory.edu.
authors.forename: Manu S
authors.initials: MS
authors.lastname: Sancheti
authors.affiliation: Department of Surgery, Division of General Surgery, Emory University, Emory University Hospital, Atlanta, Georgia.
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Emory University, Emory University Hospital, Atlanta, Georgia.
authors.forename: Shair U
authors.initials: SU
authors.lastname: Ahmed
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Emory University, Emory University Hospital, Atlanta, Georgia.
authors.forename: Allan
authors.initials: A
authors.lastname: Pickens
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Emory University, Emory University Hospital, Atlanta, Georgia.
authors.forename: Felix G
authors.initials: FG
authors.lastname: Fernandez
authors.affiliation: Department of Radiology, Emory University, Emory University Hospital, Atlanta, Georgia.
authors.forename: William C
authors.initials: WC
authors.lastname: Small
authors.affiliation: Department of Radiology, Emory University, Emory University Hospital, Atlanta, Georgia.
authors.forename: Sherif G
authors.initials: SG
authors.lastname: Nour
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Emory University, Emory University Hospital, Atlanta, Georgia.
authors.forename: Seth D
authors.initials: SD
authors.lastname: Force
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013906:Thoracoscopy / Q000379:methods*; D014057:Tomography, X-Ray Computed