Hookwire Localization of Pulmonary Nodules in Uniportal VATS

  • Ze-Rui Zhao
  • Calvin S. H. NgEmail author


In the era of uniportal thoracoscopic surgery, deep pulmonary nodules can be hard to visualize or palpate, creating an increasing demand for adjuvant modalities to localize the lesion preoperatively. Computed tomography-guided hookwire implantation has been widely adopted by thoracic surgeons due to its feasibility and high success rate. However, procedure-associated complications such as pneumothorax and wire dislodgement can cause patient discomfort or even localization failure, occasionally rendering a thoracotomy inevitable. Several measures have been proposed for optimizing the hookwire technique, including replacing the tip of the hook with a spiral helix, using a soft filament suture as a substitute for the rigid metallic tail of the wire, and use of a hookwire in combination with other localization methods such as the injection of a radionuclide marker. Centralization of the hookwire placement and simultaneous resection performed inside the hybrid theater may resolve the wire-associated complications and provide a promising, cost-effective solution in the future.


Hookwire Hybrid theater Localization 

Supplementary material

Video 1

Silk tie placed around the inner ring of the Alexis type wound retractor to facilitate removal at end of procedure (MP4 26517 kb)

Video 2

Right uniportal VATS wedge resection following hookwire inserton. The hook can be seen to have gone through the lesion into the fissure, but still very useful to locate the lesion for stapling. Moderate adhesiolysis was required and frozen section showed granulomatous inflammation (MP4 101467 kb)


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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Division of Cardiothoracic Surgery, Department of SurgeryPrince of Wales Hospital, The Chinese University of Hong KongHong Kong SARChina

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