Abstract
INTRODUCTION: Computed tomography (CT)-guided suture anchor localizer (SAL) placement is increasingly used to facilitate preoperative localization of pulmonary nodules (PNs) before video-assisted thoracoscopic surgery (VATS). Although this approach is well established for single nodules, evidence regarding its application in multiple nodules remains limited. AIM: We aimed to evaluate the safety and efficacy of CT-guided SAL placement for simultaneous localization of multiple PNs. MATERIALS AND METHODS: A 2-center retrospective study was conducted enrolling patients who underwent CT-guided SAL placement for multiple PNs followed by VATS resection between January 2023 and December 2024. A contemporaneous cohort undergoing single PN localization served as the control group. Clinical outcomes and procedural complications were compared between the groups. RESULTS: A total of 49 patients underwent the localization of 106 PNs in the multiple-nodule group, whereas 163 patients underwent the localization of 163 single PNs in the single-nodule group. The technical success of SAL placement was 100% in both groups. Localization time was longer in the multiple-nodule group (P <0.001). Pneumothorax and intrapulmonary hemorrhage occurred more frequently after multiple SAL placements (36.7% and 28.6%, respectively), as compared with single-nodule localization (18.9% and 16%; P = 0.007 and P = 0.048, respectively). Despite these differences, the technical success of VATS sublobar resection was 100% in both cohorts. CONCLUSIONS: CT-guided SAL placement is a reliable and safe method for preoperative localization of multiple PNs. Our findings supportin its clinical utility in patients undergoing VATS.