Dual-coil localization with intentional pneumothorax for pulmonary nodule resection in pediatric patients: a novel technical approach.

Intraoperative identification of small, non-palpable pulmonary nodules during video-assisted thoracoscopic surgery (VATS) remains challenging in pediatric oncology patients. We describe a novel dual-coil CT-guided localization technique in which a controlled pneumothorax is created via a parallel needle, a small coil is anchored deep to the target nodule as a fluoroscopic margin reference, and a longer coil is deployed with its terminal segment suspended freely within the pleural space to provide immediate thoracoscopic surface identification. In three consecutive pediatric oncology patients, technical success was achieved in all cases with direct thoracoscopic coil visualization, fluoroscopically confirmed negative resection margins, and no conversion to open thoracotomy. No major complications occurred. Prospective validation is warranted.