# Computed tomography–guided suture anchor localizer placement for multiple pulmonary nodule localization

## TL;DR

This study shows that CT-guided suture anchor localizers can safely and effectively locate multiple lung nodules before surgery.

## Contribution

The study provides evidence for the safety and efficacy of CT-guided SAL placement for multiple pulmonary nodules.

## Key findings

- Technical success of SAL placement was 100% for both single and multiple nodules.
- Multiple-nodule localization had higher complication rates but still achieved 100% VATS success.
- Localization time was significantly longer for multiple nodules.

## Abstract

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.

We aimed to evaluate the safety and efficacy of CT-guided SAL placement for simultaneous localization of multiple PNs.

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.

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.

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.