Feasibility of Wedge Resection for Subpleural Hilar Lung Nodules Using CT-guided Hookwire Localization and Ultrasonic Dissection

OBJECTIVE: To evaluate the safety and efficiency of a novel computed tomography (CT)-guided hookwire localization technique, aiming to enable parenchyma-sparing wedge resection using video-assisted thoracoscopic surgery (VATS) for small, hilar-proximal, ground-glass opacity (GGO)-dominant nodules. SUMMARY BACKGROUND DATA: Localizing hilar-proximal GGOs remains challenging. For small, hilar-proximal, GGO-dominant lung nodules, there is no consensus regarding the optimal surgical approach. METHODS: This was a multicenter retrospective study from January 2023 to July 2025 including 79 patients with subpleural pulmonary nodules ≤ 2 cm in diameter and consolidation-to-tumor ratio (CTR) ≤ 0.25 located near the hilum. Patients underwent preoperative CT-guided hookwire localization using transfissural or traversing-lobe approach, followed by uniportal VATS wedge resection. Resection was performed using ultrasonic dissection with limited stapler use to maximize lung preservation. RESULTS: 79 nodules (median, 7 mm, range 6-20 mm) were successfully localized. Minor asymptomatic pneumothorax occurred after localization in 12 patients and small pulmonary hemorrhage in 10 patients. The median operative time was 15.0 minutes (range 10-28 minutes). Histopathology confirmed 9 adenocarcinoma in situ, 53 minimally invasive adenocarcinoma, 14 invasive adenocarcinoma, and 3 benign lesions. 10 patients experienced persistent air leak > 72h and no other major complications occurred. Median postoperative hospital stay was 3 days (range 2 - 6 d). At a median follow-up of 17.3 months, no local recurrences or deaths have been detected. CONCLUSIONS: This novel CT-guided hookwire localization strategy proved highly effective for small, hilar-proximal, GGO-dominant lung nodules, facilitating their successful removal by VATS wedge resection with parenchyma-sparing technique.