title: Thoracoscopic resection of suspected metastatic pulmonary nodules after microcoil localization technique: a prospective study.
abstract: BACKGROUND
  Newly developed pulmonary nodules less than 20 mm in diameter in patients with a previous history of malignancy is highly suspicious to be metastatic. In this study we evaluate a new technique of computed tomography guided microcoils localization to facilitate thoracoscopic resection of deep pulmonary nodules.
  
  
  METHODS
  Seventy-four patients, who were discovered to have lung nodules (less than 20 mm) during follow up and were referred to the thoracic surgical unit in our institute from Sept. 2008 till Sept 2013, underwent CT-scan guided Microcoil localization followed by video-assisted thoracoscopic surgery (VATS) where the nodule along with microcoil was excised completely using endostaplers guided by fluoroscopy.
  
  
  RESULTS
  CT-scan guided microcoil placement was successful in all cases; however, two coils were displaced at the time of lung isolation. There was no mortality, no bleeding or hemothorax, or massive pneumothorax, no air emboli or any other post procedural complications, but a small pneumothorax occurred in 3 patients, who were managed conservatively. Mean operative time was 52.5±24.5 minutes, microcoil localization time was 43±13 minutes, and fluoroscopy time was 3±1.2 minutes. The resected nodules were inflammatory or granulomatous disease in 17 patients (23%), benign lung lesions in12 patients (16.2%), metastatic in origin in 43 patients (58.1%), and 2 patients (2.7%) primary lung cancer.
  
  
  CONCLUSIONS
  This study demonstrates that CT-guided microcoil localization is feasible, safe, and effective. It increases the success rate of VATS resection of pulmonary nodules to 100% compared with the reported 37% success rate with the non-guided approach.
authors.affiliation: Department of Surgery, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia - washajjar@yahoo.com.
authors.forename: Waseem
authors.initials: W
authors.lastname: Hajjar
authors.affiliation: Department of Surgery, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia.
authors.forename: Sami
authors.initials: S
authors.lastname: Al-Nassar
authors.affiliation: Department of Surgery, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia.
authors.forename: Omamah
authors.initials: O
authors.lastname: Almousa
authors.affiliation: Department of Surgery, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia.
authors.forename: Salah
authors.initials: S
authors.lastname: Rahal
authors.affiliation: Department of Surgery, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Aqeed
authors.affiliation: Department of Surgery, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia.
authors.forename: Iftikhar
authors.initials: I
authors.lastname: Ahmed
authors.affiliation: Department of Surgery, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia.
authors.forename: Firas
authors.initials: F
authors.lastname: Aboreida
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D005260:Female; D057918:Fiducial Markers; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D061646:Operative Time; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D015641:Radiography, Interventional; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden