title: Simultaneous Multiple Preoperative Localizations of Small Pulmonary Lesions Using a Short Hook Wire and Suture System.
abstract: OBJECTIVE
  The aim of the study was to retrospectively evaluate simultaneous multiple hook wire placement outcomes before video-assisted thoracoscopic surgery (VATS).
  
  
  METHODS
  Thirty-eight procedures were performed on 35 patients (13 men and 22 women; mean age, 59.9 years) with 80 lung lesions (mean diameter 7.9 mm) who underwent simultaneous multiple hook wire placements for preoperative localizations. The primary endpoints were technical success, complications, procedure duration, and VATS outcome; secondary endpoints included comparisons between technical success rates, complication rates, and procedure durations of the 238 single-placement procedures performed. Complications were also evaluated.
  
  
  RESULTS
  In 35 procedures including 74 lesions, multiple hook wire placements were technically successful; in the remaining three procedures, the second target placement was aborted because of massive pneumothorax after the first placement. Although complications occurred in 34 procedures, no grade 3 or above adverse event was observed. The mean procedure duration was 36.4 ± 11.8 min. Three hook wires dislodged during patient transport to the surgical suite. Seventy-four successfully marked lesions were resected. Six lesions without hook wires were successfully resected after detection by palpation with an additional mini-thoracotomy or using subtle pleural changes as a guide. The complication rates and procedure durations of multiple-placement procedures were significantly higher (P = 0.04) and longer (P < 0.001) than those in the single-placement group, respectively, while the technical success rate was not significantly different (P = 0.051).
  
  
  CONCLUSIONS
  Simultaneous multiple hook wire placements before VATS were clinically feasible, but increased the complication rate and lengthened the procedure time.
authors.affiliation: Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan, iguchi@ba2.so-net.ne.jp.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Iguchi
authors.forename: Takao
authors.initials: T
authors.lastname: Hiraki
authors.forename: Hideo
authors.initials: H
authors.lastname: Gobara
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Matsui
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Sugimoto
authors.forename: Shinichi
authors.initials: S
authors.lastname: Toyooka
authors.forename: Takahiro
authors.initials: T
authors.lastname: Oto
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Miyoshi
authors.forename: Susumu
authors.initials: S
authors.lastname: Kanazawa
mesh_terms: D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D013537:Sutures; D020775:Thoracic Surgery, Video-Assisted; D014057:Tomography, X-Ray Computed