In recent years, the widespread application of chest computed tomography (CT) screening has led to a significant increase in the detection rate of pulmonary nodules. As a critical diagnostic tool for early-stage lung cancer, video-assisted thoracic surgery (VATS) has emerged as the preferred therapeutic approach for pulmonary nodules. Clinical evidence demonstrates that precise preoperative localization significantly enhances surgical success rates (reducing conversion to thoracotomy), minimizes complications, and shortens operation time. This comprehensive review systematically evaluates six cutting-edge localization techniques: percutaneous puncture-assisted localization, electromagnetic navigation bronchoscopy (ENB) localization, 3D-printed auxiliary localization, basin-analysis-based localization, robotic navigation system localization, and mixed reality (MR)-guided localization. By critically analyzing their operational principles, efficacy, safety profiles, and clinical applicability, this paper aims to provide evidence-based recommendations for optimizing clinical decision-making in pulmonary nodule management.
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Humans ; Lung Neoplasms/diagnosis* ; Solitary Pulmonary Nodule/diagnostic imaging* ; Thoracic Surgery, Video-Assisted/methods* ; Multiple Pulmonary Nodules/diagnostic imaging* ; Tomography, X-Ray Computed

Humans ; Multiple Pulmonary Nodules ; Lung ; Lung Neoplasms/surgery* ; Solitary Pulmonary Nodule/surgery* ; Bronchoscopy

With the wide application of high-resolution chest CT in health check-up, the ground glass nodule(GGN) has been increasingly detected. GGNs have a complex etiology and image features, which can develop fast or very slowly. Therefore, whether to follow up or to resect it is usually very difficult to be determined. Overdiagnosis or overtreatment frequently happens. According to the development of GGNs, the process can be clinically divided into four stages: biological onset stage (pre-detection stage), observational stage, clinical treatment stage and postoperative follow-up stage. This review summarizes the progress on the natural development process, imaging monitoring and differentiation, the optimal time of surgical treatment for GGNs based on the decision of multidisciplinary team. This revie wmay be helpful for clinicians to understand the rule of GGN development in the follow-up, and find an optimal time to give surgical intervention for improving the prognosis of and life quality of the GGN patients.
Follow-Up Studies ; Humans ; Lung Neoplasms/surgery* ; Multiple Pulmonary Nodules/surgery* ; Retrospective Studies ; Solitary Pulmonary Nodule/surgery*

BACKGROUND: The localization of pulmonary nodules is related to whether the lesions can be found and removed accurately and quickly. It is an important link for the success of minimally invasive video-assisted thoracic surgery (VATS). This study investigated the feasibility of medical glue localization under VATS video-assisted thoracoscopic computed tomography (CT) guidance for single pulmonary nodule and more than two pulmonary nodules, and compared with the accuracy and safety of single nodule localization. METHODS: A retrospective analysis of the clinical data of patients who underwent unilateral CT-guided medical glue localization before VATS from November 2018 to March 2021 were performed, the patients was divided into multiple pulmonary nodules group (localized nodules ≥2) and single pulmonary nodule group according to the number of localized nodules. The localization time, success rate and complication rate of the two groups were compared. RESULTS: There were 126 nodules in the two groups, including 62 in single pulmonary nodule group and 64 in multiple pulmonary nodules group. The average single nodule localization time was (13.23±4.5) min in single pulmonary nodule group and (10.52±2.8) min in multiple pulmonary nodules group, the difference between the two groups is statistically significant (P<0.05). The localization success rate of single pulmonary nodule group and multiple pulmonary nodules group were 100% and 98.4% separately, the difference between the two groups was not statistically significant (P>0.05). All VATS were successfully completed after localization. The incidence of pneumothorax was higher in multiple pulmonary nodules group than in single pulmonary nodule group (P=0.07). CONCLUSIONS Compared with localization of single lung nodule, unilateral CT-guided medical glue localization for multiple pulmonary nodules before VATS is also feasible and accuracy, it is worthy of clinical application. But the higher rate of pneumothorax should be paid attention to.
Humans ; Lung Neoplasms/surgery* ; Multiple Pulmonary Nodules/surgery* ; Pneumothorax ; Retrospective Studies ; Solitary Pulmonary Nodule/surgery* ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed

Objective To investigate the application value of indocyanine green(ICG)in the localization of small pulmonary nodules in video-assisted thoracoscopic surgery(VATS). Methods We retrospectively analyzed the clinical data of 45 patients with small nodules(diameter<1 cm)who received preoperative localization with ICG and underwent VATS wedge resection from October 2020 to February 2021.The data for analysis included patients age,nodule diameter,distance from the parietal pleura,nodule density,success rate of localization,time of localization,incidence of complications,and pathological findings. Results The success rate of localization was 100%.The average nodule size was 6.3 mm,and the nodules were(10±11)mm from the parietal pleura.After localization of 59 nodules,13(22.0%)cases were found to have mild pneumothorax,and 4(6.7%)cases were found to have mild hemorrhage.The success rate of operation was 100%,and 43(72.9%)cases were confirmed adenocarcinoma by postoperative pathology. Conclusion ICG has a high success rate and good safety in the localization of small pulmonary nodules in VATS.
Humans ; Indocyanine Green ; Lung Neoplasms/surgery* ; Retrospective Studies ; Solitary Pulmonary Nodule/surgery* ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed

The magnetic anchoring lung nodule positioning device is composed of a target magnet, an anchor magnet, a coaxial puncture needle and a puncture navigation template, through these, a new type of accurate positioning technology for small pulmonary nodules is derived. The device inserts the target magnet into the both sides nearby the lung nodule under the guidance of CT. Helped by the mutual attraction of the two target magnets, they can be fixed in the lung tissue, avoiding the movement in the lung, and accurately positioning the target lung nodule before surgery. In thoracoscopic surgery, the anchor magnet and the target magnet attract each other to achieve the purpose of positioning the target nodule. The device uses the characteristics of non-contact suction of magnetic materials biomedical engineering technology, eliminating the previous procedure of direct interaction with the positioning marks, finally achieves the target of precise positioning of lung nodules and rapid surgical removal.
Humans ; Lung ; Lung Neoplasms ; Magnetic Phenomena ; Magnets ; Solitary Pulmonary Nodule ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed

BACKGROUND: Computed tomography (CT) three-dimensional reconstruction technology is increasingly used in preoperative planning of patients with ground glass nodule (GGN), but how to accurately locate the nodule and ensure the safe resection edge is still a difficult problem for clinicians. The purpose of this study was to investigate the accuracy, convenience and safety of CT three-dimensional reconstruction combined with intraoperative natural collapse localization in total thoracoscopic segmental pneumonectomy. METHODS: A total of 45 patients with radiographic findings of pulmonary GGN admitted from July 2019 to December 2019 were selected as the study group. All patients received thin-slice CT scan and underwent preoperative three-dimensional reconstruction. After anesthesia, the small thoracic operation opening and the airway of the patients were quickly opened, and the lung was rapidly and naturally collapsed by pressure difference. GGN were positioned according to the natural marker line, and marked with 3-0 prolene line. After specimen removal, the distance between the GGN and the suture mark, the distance between the GGN and the incision margin were measured, and the incision margin was routinely examined. The general clinical data, pathological data and postoperative complications were counted and compared with 45 consecutive patients who were located with hookwire positioning needle in the same period. RESULTS: The average localization time of non-invasive GGN with natural lung collapse during operation was 6.9 min, and the localization accuracy was 90.6%. There were 2 cases of extensive pleural adhesion and 1 case of emphysema. Postoperative pathology was confirmed as lung adenocarcinoma, and the examination of incision margin was negative. No GGNs were scanned again after surgery, and the precise resection rate of lung segment was 100.0%. CONCLUSIONS CT three-dimensional reconstruction combined with GGN localization of natural lung collapse during operation can shorten the time of searching for GGN during operation and guarantee the safety of the incision margin. It is a more economical and convenient localization method and makes pulmonary segment resection more accurate.
Humans ; Imaging, Three-Dimensional ; Lung/surgery* ; Lung Neoplasms/surgery* ; Pulmonary Atelectasis ; Retrospective Studies ; Solitary Pulmonary Nodule ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed

To evaluate the value and clinical effect of different preoperative localization techniques for solitary pulmonary nodules (SPN) before single-port thoracoscopic surgery.From January 2018 to June 2019, 54 patients diagnosed with solitary pulmonary nodules received single-port thoracoscopic surgery in Thoracic Department of General Hospital of Southern Theater Command of PLA. Based on the location methods of the nodules, the patients were divided into group A (34 cases) with preoperative CT-guided Hook-wire (a common positioning needle usually using in mammary gland) positioning and group B (20 cases) with preoperative CT-guided methylene blue location.The success rate of localization in group A was 94.18% (32/34), significantly higher than that in group B [85% (17/20), < 0.05). No intraoperative conversion to thoracotomy occurred in group A, while the conversion rate was 10% (2/20) in group B ( < 0.05). The average positioning cost was significantly higher in group A than in group B (1715±109 1021±86 RMB yuan, < 0.05), but the total hospitalization cost was similar between the two groups (50 114±3788 47871±5902 RMB yuan, >0.05). The length of hospital stay was significantly shorter in group A than in group B (6.71±1.23 8.19±2.61 days, < 0.05).Compared with the traditional methylene blue localization method, Hook-wire localization positioning can significantly increase the success rate of localization, and can be used as the standard preoperative localization method in patients undergoing single-port thoracoscopic pulmonary nodule resection, especially in those with deep nodule location from the visceral pleura.
Humans ; Lung Neoplasms ; Preoperative Care ; Solitary Pulmonary Nodule ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed

Recently, with the proliferation of high-resolution computed tomography (CT), the frequency of small pulmonary nodules appears higher and more precise than previously estimated, especially in CT screening in patients with high risk factors for lung cancer. Video-assisted thoracoscopic surgery (VATS) provides a new minimally invasive treatment for the diagnosis and treatment of small pulmonary nodules. The VATS results in less pain, shorter hospital stay, and reduced surgical complications, making it more widely available. How to accurately locate and mark lesions is important for video-assisted thoracoscopic surgery. This article reviews the various techniques used to locate pulmonary nodules in surgery in recent years and summarizes the advantages and disadvantages of them.
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Humans ; Lung Neoplasms ; surgery ; Metals ; Solitary Pulmonary Nodule ; surgery ; Surgery, Computer-Assisted ; Thoracic Surgery, Video-Assisted ; methods

Pulmonary ground glass nodule (GGN) is a term of radiological manifestation, which may be malignant or benign. The management for pulmonary GGN remains controversial. Both Fleischner society and National Comprehensive Cancer Network (NCCN) panel updated the guideline for the management of GGN in 2017. Compared with previous versions, the indication for surgery or biopsy is stricter, and the recommended follow-up interval is prolonged. In clinical practice, the size of GGN component, the size of consolidation component, dynamic change during follow-up and computed tomography (CT) value are the four factors that help surgeons to decide the timing of surgery. There are some misunderstandings for the management of GGN, such as the administration of antibiotics, the use of positron emission tomography-computed tomography (PET-CT), pure GGN adjacent to visceral pleura, and GGN with penetrating vessel. In conclusion, GGN is a kind of slowly growing lesion, which can be followed up safely.
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Humans ; Positron Emission Tomography Computed Tomography ; Retrospective Studies ; Solitary Pulmonary Nodule ; diagnosis ; diagnostic imaging ; surgery