Localization of small peripheral pulmonary nodules for surgical resection: a new intraoperative technique in hybrid operating room

Objective: The purpose of this study was to introduce a new feasible and effective intraoperative localization technique for small peripheral pulmonary nodules in hybrid operating room. Methods: Between June 2020 and June 2021, the intraoperative localization was performed in 27 patients for 35 small pulmonary nodules at our institution. The procedure was undergone under thoracoscopic observation. After making the VATS ports, a titanium clip was clipped at the visceral pleura as near the pulmonary nodule as possible to be a marker for the nodule. VATS resection was performed next. Results: A total of 27 patients were included in this study, including 6 males and 21 females. The median age was 58 years (range 34-78 years). All surgeries were performed by two-port VATS. A total of 35 pulmonary nodules underwent intraoperative localization. The mean diameter of nodules was 10.6 ± 3.7 mm. The distance of nodules to visceral pleura was 8.3 ± 8.7 mm. The mean localization time was 23.3 ± 3.3 min. The median time of C-arm scanning was 3 (range, 2-4) times. All the nodules were localized successfully and resected precisely. No VATS were converted to thoracotomy. There were no complications related to localization procedures. Conclusions: This new intraoperative localization technique was feasible, safe and effective. And also the intraoperative procedure could avoid extra suffering for patients.