Video‐assisted Thoracoscopic Resection of a Small Pulmonary Nodule after Computed Tomography–guided Localization with a Hook‐wire System

Background This study is a single‐institution validation of video‐assisted thoracoscopic (VATS) resection of a small solitary pulmonary nodule (SPN) previously localized by a CT‐guided hook‐wire system in a consecutive series of 45 patients. Methods The records of all patients undergoing VATS resection for SPN preoperatively localized by CT‐guided a hook‐wire system from January 2002 to December 2004 were assessed with respect to failure to localize the lesion by the hook‐wire system, conversion thoracotomy rate, duration of operation, postoperative complications, and histology of SPN. Results Forty‐five patients underwent 49 VATS resections, with simultaneous bilateral SPN resection performed in 4. Preoperative CT‐guided hook‐wire localization failed in two patients (4%). Conversion thoracotomy was necessary in two patients (4%) because it was not possible to resect the lesion by a VATS approach. The average operative time was 50 min. Postoperative complications occurred in 3 patients (6%), one hemothorax and two pneumonia. The mean hospital stay was 5 days (range: 2–18 days). Histological assessment revealed inflammatory disease in 17 patients (38%), metastasis in 17 (38%), non‐small‐cell lung cancer (NSCLC) in 4 (9%), lymphoma in 3 (6%), interstitial fibrosis in 2 (4%), histiocytoma in one (2%), and hamartoma in one (2%). Conclusions Histological analysis of resected SPN revealed unexpected malignant disease in more than 50% of the patients indicating that histological clarification of SPN seems warranted. Video‐assisted thoracoscopic resection of SPN previously localized by a CT‐guided hook‐wire system is related to a low conversion thoracotomy rate, a short operation time, and few postoperative complications, and it is well suited for the clarification of SPN.