Video-assisted thoracic surgery for tiny pulmonary nodules with real-time image guidance in the hybrid theatre: the initial experience

Localization is an important step in wedge resection of lung nodules with a view to accurate resection and achieving adequate surgical margin. For lesions that are small, soft in consistency (e.g., with high ground-glass opacity percentage), or distant from the visceral pleura (e.g., depth greater than twice lesion diameter) (1), digital palpation as the simplest way of intraoperative localization can be unreliable. Furthermore, the limited access during minimally invasive thoracic surgery can increase the difficulty of nodule localization. In the appropriate clinical context, such as history of pulmonary or extra-pulmonary malignancy in which pulmonary recurrence or metastasis remain a top differential diagnosis, continuing imaging surveillance of these small nodules may delay diagnosis and treatment of the condition. In certain cases surgical resection can be both diagnostic and therapeutic