NEEDLE LOCALIZATION OF PERIPHERAL LUNG NODULES FOR VIDEO-ASSISTED THORACOSCOPIC SURGERY

Video-assisted thoracoscopic surgery provides an alternative to conven tional thoracotomy for resection of peripheral lung nodules. To locali ze small peripheral lung nodules that may not be visible or palpable b y the surgeon, we have placed a Kopans hook wire percutaneously into t he lung as a guide. The indications for localization included previous nondiagnostic percutaneous needle aspiration biopsy (PNAB) (n=4), nod ules too small for PNAB (n=2), nodules inaccessible to PNAB (n=3), and planned resection of a known peripheral tumor less than 1 cm (n=1). T he localization procedure was performed with computed tomographic guid ance in all patients. The nodules ranged in size from 2 to 15 mm and w ere located immediately subpleural to 2-cm deep the pleura. A 20-gauge Greene biopsy needle was used as an introducer for a 35-cm-long Kopan s hook wire. Patients were sent directly to the operating room in a de pendent position. All ten nodules were successfully resected, includin g hamartoma (n=1), carcinoid tumors (n=2), granulomas (n=3), adenocarc inoma (n=1), fibrosis (n=1), benign metastasizing leiomyoma (n=1), and lymphoma (n=1). In two patients, the wire slipped out of the lung. Sm all focal pneumothoraces developed in five patients. There were no maj or complications. This procedure can safely and effectively localize n onvisible or nonpalpable pulmonary nodules for thoracoscopic surgery f or diagnostic purposes or for resection of small peripheral tumors in patients who cannot tolerate a lobectomy or pneumonectomy.