A novel localization technique for margin distance assessment of deep-seated small pulmonary nodules in thoracoscopic wedge resection: a retrospective study.

Background: Thoracoscopic wedge resection of deep-seated small pulmonary nodules (SPNs) with an adequate surgical margin distance is a challenging yet crucial aspect of successful resection. In our previous study, we introduced a novel localization technique for SPN wedge resection with sufficient margin distance. The aim of the present study was to evaluate margin distance assessment of this localization technique for deep-seated SPNs in wedge resection by standardizing the surgical procedures. Methods: From November 2021 to October 2023, 73 patients with deep-seated SPNs who underwent computed tomography (CT)-guided localization followed by thoracoscopic wedge resection were enrolled. A device characterized by a 4-hook claw and a tri-colored suture with a scale was utilized for localization. Clinical data were collected to evaluate the efficiency of the procedure in obtaining a sufficient margin distance for deep-seated SPN wedge resection. Results: A total of 73 patients were included. The median size of the nodules was 10.7 mm (range, 5-23 mm), and the median nodule depth was 25.3 mm (range, 20-49 mm). Needle localization was successful without dislodgment in 68 of the 73 patients (93.2%), and all nodules were completely wedge resected. No complications from localization required further medical intervention. The median resection margin distance was 14.4 mm (range, 4-29 mm), and the resection margin distance was more than 5 mm in 72 of the 73 cases (98.6%). A total of 62 of the 73 cases (84.9%) had a margin distance to tumor size ratio of ≥1. Conclusions: This study provides preliminary evidence that CT-guided 4-hook needle with scaled suture localization for deep-seated SPNs, followed by wedge resection, is an efficient method. Furthermore, it is beneficial in obtaining adequate margin distances for wedge resection.