Abstract
BACKGROUND: Accurate localization of small pulmonary nodules (SPNs) during video-assisted thoracoscopic surgery (VATS) is challenging due to the small size and deep location. Both the 4-hook wire technique and methylene blue are significant methods for preoperative localization of SPNs. This study aimed to compare the safety of both methods by monitoring and recording any surgery-related complications. Additionally, the effectiveness of both methods was compared by measuring the success rate of localization and the time required for both localization and resection of the nodules. METHODS: Patients who underwent computed tomography (CT)-guided lung nodule localization before VATS from May 2021 to April 2023 at Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College were analyzed retrospectively. A total of 75 patients with 84 SPNs were included in this study, comprising 35 4-hook anchor patients with 41 SPNs and 40 methylene blue-marked patients with 43 SPNs. RESULTS: The VATS operative time for SPNs in the 4-hook anchor device group was significantly shorter than that in the methylene blue group (57.4±12.4 vs. 79.5±14.3 minutes; P<0.001). The overall puncture operation time [15.0 (13.0, 16.5) vs. 16.00 (13.8, 21.0); P=0.007] was also significantly different between the 4-hook anchor device group and the methylene blue group. There were no significant differences in localizer depth from the pleura, complications, localization success, hemorrhage, hospital stay, or hospital cost between the two groups (all P>0.05). CONCLUSIONS: Compared with the methylene blue technique, the 4-hook anchor device is safe and reliable and offers a shorter VATS operative time.