Evaluation of the need for preoperative short hookwire placement for small pulmonary lesions

Purpose: Although preoperative marking is often required to accurately locate the targets for video-assisted thoracic surgery, target lesions can be identified intraoperatively without marking in some cases; however, the frequency and characteristics of these lesions remain unclear. Therefore, we aimed to retrospectively evaluate the need for a short hookwire for preoperative localization of small pulmonary lesions. Materials and methods: Computed tomography (CT)-guided short hookwire placement was performed for 176 lesions (mean diameter, 7.9 ± 3.5 mm) in 171 sessions prior to video-assisted thoracoscopic surgery. Placement was performed if one or more of the following CT findings were present: lesions (1) ≤ 10 mm in diameter; (2) ≥ 5 mm from the pleural surface, and (3) predominantly consisting of ground-glass opacity. The need for a hookwire for intraoperative lesion detection was retrospectively assessed based on surgical records. Factors associated with the absence of a hookwire for lesion detection were determined using univariate and multivariate analyses. Results: Placement was successful in all cases; however, the hookwire was dislodged at the time of surgery in four lesions (2%). Among the remaining 172 lesions, thoracoscopic resection was performed using a hookwire as a landmark in 101 lesions (58.7%), whereas 71 lesions (41.3%) were detectable without a hookwire. Previous ipsilateral lung resection significantly increased the odds of not needing a hook wire (OR 4.24; P = 0.005). Larger target lesions (mean, 8.4 vs. 7.1 mm) and those located further from the pleura (mean, 13.3 vs. 8.0 mm) were associated with an increased need for hook wires. Multivariate analysis revealed that experienced surgeons required more hookwires compared to trainees (P = 0.029). Solid nodules did not require hookwires (P = 0.032). Conclusion: Shallow solid lesions in patients with a history of ipsilateral lung resection may not require hookwire placement during resection, even if they are small.