Computed tomography-guided simultaneous coil localization of multiple pulmonary nodules before video-assisted thoracoscopic surgery

Introduction
Currently, different methods and materials are used to localize pulmonary nodules (PNs) but most are used only to locate a single pulmonary nodule (PN). Aim: To evaluate the feasibility and safety of simultaneously localizing multiple PNs with a coil under computed tomography (CT) guidance before video-assisted thoracoscopic surgery (VATS).

Material and methods
A total of 166 patients underwent VATS preoperative-assisted localization of pulmonary nodules in our hospital in the period from January 2, 2020 to July 7, 2020, namely 40 patients in the multiple-PN-simultaneous-localization group (A) and 126 patients in the single-PN-localization group (B). We compared the epidemiology, localization procedure, and complications between the two groups.

Results
The technical success rates in group A and Group B were 96.5% and 97.6%, respectively, with no statistical difference (p = 0.623). In group A, the success rate of the first nodule localization was 100%, and the subsequent nodule localization success rate was 93.3%; three patients had one nodule localization failure owing to pneumothorax after the first nodule localization. The number of pleural punctures was higher in group A than in group B (p < 0.001), and the localization procedure time was longer than in group B (p < 0.001). Regarding complications, the pneumothorax rate in group A was higher than that in group B (p < 0.001), and the bleeding rate was higher than that in group B (p < 0.001). However, pneumothorax and bleeding in group A did not require special treatment.

Conclusions
The incidence of pneumothorax and pulmonary hemorrhage with simultaneous coil localization of multiple PNs was higher than that with localization of a single PN, but this method was safe and feasible.