Clinical outcomes of short hook wire and suture marking system in thoracoscopic resection for pulmonary nodules

Objective: The short hook wire and suture marking system is a device for localization of small pulmonary nodules in thoracoscopic resection. We and other authors have shown the feasibility of the marking procedure. In this study, we reviewed our recent experience to examine the problems for resecting procedure using the device and determine if the system negatively impacts the survival rates for lung cancers. Methods: Between November 1996 and March 2007, a total of 125 pulmonary nodular lesions in 108 patients were intended for thoracoscopic resection after localization with computed tomography-guided short hook wire and suture placement. We reviewed the major problems during surgery among all cases and prognosis in 64 patients with primary lung cancer. Results: One hundred and seventeen lesions (93.6%) were successfully resected by intitial resection with no major complication. However, we experienced missing events, the major problem during surgery, which was defined as temporarily missing lesions or hook wires. Eight missing events (6.4%) consisting of five unresected lesions and three remaining hook wires occurred after initial wedge resection. All the missing lesions and one remaining hook wire were recovered by additional resection. No specific factors of lesions, including location, diameter, distance from the pleural surface, and opacification were related to incidence of the 'missing event'. Five-year survival of patients with stage IA lung cancer was 90.0% with no local recurrence. Conclusions: Our localization method assured a consistent quality of resection regardless of the lesion characteristics and a reasonable prognosis for patients with primary lung cancer. The short hook wire and suture system provides acceptable utility in thoracoscopic surgery.