Impiego dei fili metallici sotto guida con tomografia computerizzata per la localizzazione pre-toracoscopica di noduli polmonari periferici

The recent developments in thoracic surgery have broadened the application spectrum of thoracoscopy. Video-assisted thoracoscopic lung resection is now available both to diagnose and to treat peripheral pulmonary nodules. A major factor limiting the success of thoracoscopic lung resection is the difficult localization of the pulmonary nodule. When lesions are very small and deep inside the lung, their preoperative detection may be difficult. This study was aimed at investigating the effectiveness of hookwires for CT-guided localization of peripheral pulmonary lesions requiring thoracoscopic resection. In 12 patients 12 nodules, previously detected with chest radiography, were localized with hookwires under CT guidance. Ten of 12 patients underwent thoracoscopic resection for diagnostic purposes, while the extant two patients underwent therapeutic wedge resection. In all patients prethoracoscopic hookwire positioning was successful. In 11 of 12 patients the lesion was accurately localized, while in the extant patient the wire tip was inserted deeper than the nodule. In 3 patients the wire was dislodged before surgery: in all of them a small hemorrhage developed on the visceral pleura and wedge resection was likewise possible. Four patients had a small pneumothorax which was not treated before surgery. In conclusion, percutaneous hookwire localization of peripheral lung lesions is an easy and efficacious technique and promotes thoracoscopy as a less invasive alternative to thoracotomy.