title: Retrospective Evaluation of Safety, Efficacy and Risk Factors for Pneumothorax in Simultaneous Localizations of Multiple Pulmonary Nodules Using Hook Wire System.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of the hook wire system in the simultaneous localizations for multiple pulmonary nodules (PNs) before video-assisted thoracoscopic surgery (VATS), and to clarify the risk factors for pneumothorax associated with the localization procedure.
  
  
  METHODS
  Between January 2010 and February 2016, 67 patients (147 nodules, Group A) underwent simultaneous localizations for multiple PNs using a hook wire system. The demographic, localization procedure-related information and the occurrence rate of pneumothorax were assessed and compared with a control group (349 patients, 349 nodules, Group B). Multivariate logistic regression analyses were used to determine the risk factors for pneumothorax during the localization procedure.
  
  
  RESULTS
  All the 147 nodules were successfully localized. Four (2.7%) hook wires dislodged before VATS procedure, but all these four lesions were successfully resected according to the insertion route of hook wire. Pathological diagnoses were acquired for all 147 nodules. Compared with Group B, Group A demonstrated significantly longer procedure time (p < 0.001) and higher occurrence rate of pneumothorax (p = 0.019). Multivariate logistic regression analysis indicated that position change during localization procedure (OR 2.675, p = 0.021) and the nodules located in the ipsilateral lung (OR 9.404, p < 0.001) were independent risk factors for pneumothorax.
  
  
  CONCLUSIONS
  Simultaneous localizations for multiple PNs using a hook wire system before VATS procedure were safe and effective. Compared with localization for single PN, simultaneous localizations for multiple PNs were prone to the occurrence of pneumothorax. Position change during localization procedure and the nodules located in the ipsilateral lung were independent risk factors for pneumothorax.
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhong
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China.
authors.forename: Xiao-Quan
authors.initials: XQ
authors.lastname: Xu
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Xiang-Long
authors.initials: XL
authors.lastname: Pan
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China.
authors.forename: Hai
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Yuan
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China.
authors.forename: Ling-Yan
authors.initials: LY
authors.lastname: Kong
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China.
authors.forename: Xue-Hui
authors.initials: XH
authors.lastname: Pu
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China. njmu_yutongfu@163.com.
authors.forename: Tong-Fu
authors.initials: TF
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D008168:Lung / Q000473:pathology / Q000601:surgery; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000473:pathology* / Q000601:surgery*; D015999:Multivariate Analysis; D061214:Patient Safety; D011030:Pneumothorax / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000295:instrumentation*; D016896:Treatment Outcome
keywords: Hook wire system; Localization; Pneumothorax; Pulmonary nodules; Video-assisted thoracoscopic surgery