Image-guided video-assisted thoracoscopic localization and resection for multiple ipsilateral pulmonary nodules

Background: The separated preoperative computed tomography-guided localization of multiple ipsilateral pulmonary nodules was difficult and with various complications, including pneumothorax and hemothorax. The introduction of image-guided video-assisted thoracoscopic surgery (iVATS) which combined intraoperative localization and the following VATS has solved these difficulties. The study examines the feasibility of using the ARTIS pheno system to localize multiple ipsilateral pulmonary nodules and the related complications. Materials and Methods: Retrospective analysis of iVATS using the ARTIS pheno dye-based localization for multiple ipsilateral lung nodules at a single institution from June 2018 to July 2021. Results: Totally 84 patients with 190 resected nodules were enrolled. 31 (37%) were men and 40 (48%) patients with a history of malignancy. The average localization procedure time was 16 min (interquartile range [IQR]: 13-19 min), and 4 (4.8%) patients developed slight pneumothorax after localization. The overall localization success rate was 99.5%, and one failed due to dye overflow on the lung surface. Among localized nodules, 89 (47%) were ground-glass opacities (GGOs), 97 (51%) were subsolid GGOs, and 4 (2%) were substantive nodules. 139 (73%) nodules were malignant, and 51 (27%) were benign. The average length of hospital stay was 5 days (IQR: 4-8 days). Conclusion: The utilization of the ARTIS pheno system is safe and feasible for performing dye localization of multiple ipsilateral pulmonary nodules. Thoracic surgeons can complete multiple needle punctures in a single end-inspiratory apnea period, reducing localization procedure times, and complication risks.