CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature.
BACKGROUND
Video-assisted thoracoscopic surgery (VATS) is standard of care for small lung resections at many centres. Computed tomography (CT)-guided insertion of microcoils can aid surgeons in performing VATS resections for non-palpable lung nodules deep to the lung surface.


METHODS
Retrospective analysis of CT-guided microcoil insertions prior to VATS lung resection at a single institution from October 2008 to January 2014.


RESULTS
A total of 63 patients were included (37% male, mean age 61.6±11.4 years). Forty-two patients (67%) had a history of smoking, with 10 current smokers. Sixty one (97%) patients underwent wedge resection and 3 (5%) patients had segmentectomy. Three (5%) patients required intra-operative staple line re-resection for positive or close margins. Eleven (17%) patients had a completion lobectomy, 5 of which were during the same anaesthetic. The average time between the CT-guided insertion and start of operation was 136.6±89.0 min, and average operative time was 84.0±53.3 min. The intra-operative complication rate was 5% (n=3), including 1 episode of hemoptysis, and 2 conversions to thoracotomy. The post-operative complication rate was 8% (5 patients), and included 2 air leaks, 1 hemothorax (drop in hemoglobin), 1 post chest tube removal pneumothorax, and one venous infarction of the lingula after lingula-sparing lobectomy requiring completion lobectomy. . Average post-operative length of stay was 2.2 days. A diagnosis was made for all patients.


CONCLUSIONS
CT-guided microcoil insertion followed by VATS lobectomy is safe, with short operative times, short length of stay and 100% diagnosis of small pulmonary nodules. This technique will become more important in the future with increasing numbers of small nodules detected on CT as part of lung cancer screening programs.
Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada.
Laura L
LL
Donahoe
Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
Elsie T
ET
Nguyen
Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
Tae-Bong
TB
Chung
Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
Lan-Chau
LC
Kha
Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada.
Marcelo
M
Cypel
Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada.
Gail E
GE
Darling
Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada.
Marc
M
de Perrot
Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada.
Shaf
S
Keshavjee
Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada.
Andrew F
AF
Pierre
Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada.
Thomas K
TK
Waddell
Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada.
Kazuhiro
K
Yasufuku
Video-assisted thoracoscopic surgery (VATS); computed-tomography-guided microcoil localization (CT-guided microcoil localization); lung nodules