Hookwire Localization of Pulmonary Nodules in Uniportal VATS

Abstract

In the era of uniportal thoracoscopic surgery, deep pulmonary nodules can be hard to visualize or palpate, creating an increasing demand for adjuvant modalities to localize the lesion preoperatively. Computed tomography-guided hookwire implantation has been widely adopted by thoracic surgeons due to its feasibility and high success rate. However, procedure-associated complications such as pneumothorax and wire dislodgement can cause patient discomfort or even localization failure, occasionally rendering a thoracotomy inevitable. Several measures have been proposed for optimizing the hookwire technique, including replacing the tip of the hook with a spiral helix, using a soft filament suture as a substitute for the rigid metallic tail of the wire, and use of a hookwire in combination with other localization methods such as the injection of a radionuclide marker. Centralization of the hookwire placement and simultaneous resection performed inside the hybrid theater may resolve the wire-associated complications and provide a promising, cost-effective solution in the future.