Using an image-guided navigation system for localization of small pulmonary nodules before thoracoscopic surgery

Background: Video-assisted thoracic surgery (VATS) provides a minimally invasive means to resect small pulmonary nodules (SPN). However, thoracoscopy has limits in the detection of small nodules, which are invisible and/or impalpable during surgery. Methods to localize such lesions, including methylene blue injection or the introduction of a hookwire under the guidance of computed tomography (CT), have some limitations. We are developing a new technique using image-guided navigation system for localization of small pulmonary nodules before thoracoscopic surgery. Methods: Four pigs underwent spiral-computed tomography ( CT) scanning after they were given percutaneously created pulmonary lesions. The CT data were transmitted to a StealthStation navigation system, and with the help of the probe the lesions were located and resected under thoracoscopy. Results: A total of 20 lesions were created. Nodules were located at an average distance of 15.6 mm from the pleural surface. All the lesions were successfully localized, and biopsy specimens revealed successful resection of target material. Conclusion: This method can provide appropriate guidance to small pulmonary nodules and prove effective in immediately facilitating subsequent thoracoscopic resection.