Abstract
Background
Computed tomography (CT)-guided percutaneous lung biopsy localization plays a pivotal role in the diagnosis and management of thoracic diseases. The present study aimed to investigate and compare a laser localization system with traditional puncture technology, focusing on their accuracy and safety in clinical practice.
Methods
A total of 120 patients who required preoperative CT-guided percutaneous lung nodule localization between October 2023 and October 2024 were prospectively enrolled. Among them, 60 patients who underwent puncture under CT guidance with the assistance of a laser locator were assigned to the observation group, and 60 patients who received conventional CT-guided puncture were allocated to the control group. Adverse reactions related to percutaneous lung puncture were recorded according to the Common Terminology Criteria for Adverse Events (CTCAE 5.0). The puncture time, average number of CT scans, one-time puncture success rate, and incidence of complications were compared between the two puncture methods.
Results
The average diameter of lung nodules in the observation group was 0.85±0.38 cm, with a one-time puncture success rate of 93.3% (56/60); in the control group, the average diameter of lung nodules was 0.87±0.31 cm, and the one-time puncture success rate was 83.3% (50/60). Compared with the control group, the observation group had fewer average CT scans (3.53±1.40 vs. 5.80±1.56 times), shorter puncture time (7.63±3.51 vs. 11.00±5.31 min), and lower radiation dose (45.81±12.41 vs. 65.28±15.16 mSv), with statistically significant differences (all P<0.05). When comparing the puncture errors of nodules in different lung lobe locations between the two groups, the results showed that in the observation group, the puncture error for lower lobe nodules was significantly greater than that for non-lower lobe nodules (2.48±0.65 vs. 1.90±0.31 mm, P<0.05); similarly, in the control group, the puncture error for lower lobe nodules was also greater than that for non-lower lobe nodules (3.61±1.72 vs. 2.58±0.52 mm, P<0.05).
Conclusions
The laser locator-assisted CT-guided percutaneous lung biopsy yields favorable procedural outcomes, with shorter operation time, fewer repeated scans and lower radiation exposure. Although no significant difference was found in the one-time puncture success rate versus the conventional method, this auxiliary localization system shows promising clinical value. Further large-scale multicenter trials are required to validate its efficacy and routine clinical applicability.
Keywords: Computed tomography (CT), laser localization system, lung nodule, preoperative localization, respiratory motion
Introduction
The widespread application of low-dose computed tomography (CT) in clinical screening and routine physical examinations has significantly improved the detection rate of asymptomatic lung nodules, particularly small and subsolid nodules that were previously undetectable by conventional imaging modalities (1). This epidemiological change has brought tremendous diagnostic and therapeutic pressure to clinicians and psychological burden to patients, as the differential diagnosis of lung nodules (benign vs. malignant) directly determines the subsequent treatment strategy and long-term prognosis (2). Video-assisted thoracoscopic surgery (VATS), as a representative minimally invasive thoracic surgical technique, has gradually replaced traditional open thoracotomy as the preferred treatment for small lung nodules due to its advantages of less trauma, faster postoperative recovery, and lower complication rates (3,4). It is especially suitable for elderly patients, those with poor cardiopulmonary function, and other populations who cannot tolerate invasive thoracotomy, thereby expanding the indications for surgical treatment of lung nodules.
However, intraoperative localization of lung nodules remains a major clinical challenge in VATS, especially for nodules located deep in the lung parenchyma, with small diameter (<10 mm), or of non-solid type (ground-glass opacity or part-solid nodules). Unlike open thoracotomy, VATS lacks direct tactile feedback, making intraoperative palpation of such nodules extremely difficult or even impossible. Accurate preoperative localization is therefore crucial for the success of VATS resection, positioning deviations can not only lead to unnecessary expansion of the resection range (e.g., converting segmentectomy to lobectomy), which may impair lung function, but also result in failure to resect the target nodule, requiring reoperation or additional invasive procedures, thereby increasing the physical and economic burden on patients (5,6). CT-guided percutaneous lung puncture localization has emerged as an effective auxiliary technique to solve this problem, of which its core principle is to accurately place a locator (such as a hook wire, microcoil, or dye) near the target nodule under real-time CT monitoring, providing clear intraoperative guidance for surgeons (7-9).
Despite the continuous advancement of imaging and puncture technologies, the accuracy of CT-guided percutaneous localization is still affected by multiple factors, among which respiratory motion (leading to displacement of the lung nodule during the puncture process) and operator-dependent experience are the most prominent. Currently, a variety of CT-guided localization techniques have been applied in clinical practice, including hook-wire localization, fluorescence navigation, and microcoil localization (10-12). However, these techniques all have inherent limitations, they heavily rely on the operator’s proficiency in puncture skills and judgment of imaging images, which may easily lead to increased puncture attempts, prolonged operation time, and elevated risks of complications such as pneumothorax, hemoptysis, and pleural effusion. To address these clinical dilemmas, the laser localization system, with its advantages of real-time guidance, high precision, and minimal invasiveness, has been proposed as a potential alternative. Therefore, this prospective pilot study was designed to systematically evaluate the feasibility, safety, and clinical application value of the laser localization system in CT-guided percutaneous lung puncture positioning, providing high-quality clinical evidence for its popularization and application in the treatment of lung nodules. We present this article in accordance with the CONSORT reporting checklist (available at https://qims.amegroups.com/article/view/10.21037/qims-2026-1-0404/rc).
Methods
Patients and data collection
This prospective study was approved by the Ethics Committee of The Eighth Affiliated Hospital of Southern Medical University (No. KYLS20231056) and was conducted in accordance with the Declaration of Helsinki and its subsequent amendments, and all patients signed informed consent forms. A total of 120 patients diagnosed with lung nodules at The Eighth Affiliated Hospital of Southern Medical University between October 2023 and October 2024 were enrolled. Inclusion criteria: (I) lung nodules diameter ≤3 cm; (II) patients and their families consented to puncture. Exclusion criteria: (I) pulmonary nodules adjacent to the heart, mediastinum or large blood vessels; (II) presence of severe emphysema, pulmonary hypertension or other severe cardiopulmonary diseases; (III) coagulation dysfunction with increased bleeding risk; (IV) inability to cooperate with breathing training and intraoperative posture requirements; (V) patients who refused puncture intervention or voluntary withdrew from the study. Given that this was a prospective preliminary clinical trial and the laser navigation system provides real-time visual intraoperative guidance, the operators must observe the laser trajectory and adjust the puncture pathway dynamically. For this reason, complete double-blinded design was not feasible in this interventional procedural study. To minimize selection bias, strict simple randomization was performed in advance. An independent researcher generated a random number sequence, and enrolled patients were assigned at a 1:1 ratio to either the laser-assisted localization group or the conventional CT-guided puncture group. Specifically, a total of 120 patients were randomly divided into two groups using a simple randomization procedure: a random number was generated for each patient, with odd numbers allocated to the observation group (laser locator assisted puncture) and even numbers assigned to the control group (conventional puncture). Adequate allocation concealment was fully implemented throughout the grouping process to further reduce selection bias. The random allocation information was strictly concealed throughout the study. Blinding was maintained for patients and outcome assessors, while only the interventional radiologists were unblinded due to the operational requirements of the laser device. Although double-blinding could not be achieved, we adopted unified operators, standardized procedural protocols, and rigorous random grouping to control potential confounding factors and reduce assessment bias. In addition, all patients underwent blood routine and coagulation function tests before puncture to ensure procedural safety. The enrollment, randomization and grouping of participants in this study are presented in Figure 1.
Figure 1.
Flow diagram of patient enrollment, randomization, and allocation in the present study. CT, computed tomography.
Laser localization system
For preoperative CT-guided lung nodule localization, we adopted a clinically approved laser localization system, manufactured by Aoruidi Medical Technology Co., Ltd. based in Shangrao, China (Model: Follict). This system has been cleared as a class II medical device by the National Medical Products Administration (NMPA). The system consists of two core components: a laser localizer and a suspension system, and is further integrated with a photoelectric navigation subsystem, which is purpose-built for precision thoracic interventional procedures. Figure 2 shows the laser localization system.
Figure 2.
The laser localization system. (A) The operation control panel of the laser localizer, with a digital display module for 3-axis (X/Y/Z) positioning parameter setting and calibration. (B) The full view of the mobile laser localization system, which consists of a laser localizer, a cantilever suspension system and a movable base. (C) The complete clinical application platform of the laser localization system matched with the CT scanner for preoperative lung nodule puncture localization. CT, computed tomography.
Respiratory training methods
All patients received rigorous respiratory training before the examination, referring to the Chinese expert consensus on cone-beam CT-guided diagnosis, localization, and treatment of pulmonary nodules (13,14), as follows: (I) quiet breathing training (3 minutes): patients were instructed to adopt abdominal breathing (to reduce thoracic movement) with a frequency controlled at 12–16 times/min to ensure stable amplitude. (II) Targeted apnea training: (i) end-inspiratory breath-holding: patients took a deep breath to 80–90% of vital capacity (avoiding full inspiration to reduce intrathoracic pressure changes), maintained breath-holding for 10–15 seconds, and repeated 3–5 times with 30-second intervals; (ii) end-expiratory breath-holding: patients exhaled quietly to functional residual capacity and maintained breath-holding for 10–15 seconds, suitable for lower lobe nodules (as the diaphragm position is more stable at this time). (III) Simulated puncture breathing coordination: training was performed on the CT scanning table, with the operator issuing instructions (e.g., “Inhale - Hold breath - Puncture”). A laser locator was used to simulate needle insertion, and thoracoabdominal movement during the patient’s breath-holding was observed. The impact of respiratory motion on puncture errors of nodules in different locations and the effectiveness of the laser locator were evaluated; puncture error assessment referred to the expert consensus on preoperative auxiliary localization technology for small pulmonary nodules (2019 Edition) (15).
CT scanning and operation methods
Observation group puncture was performed using a laser locator, which consists of a trolley and a laser localization system installed on its track. The laser localization system is located above the patient and emits a laser beam to guide the angle of surgical operation, including a built-in power supply, electronic components, switches, mechanical components, and a laser generator. The laser localization system includes a built-in line laser for calibrating the position of the CT examination table and an adjustable point laser beam for tumor localization guidance. Before use, an automatic calibration system is used to ensure the accuracy of the required angle.
Observation group operation methods: (I) initial CT scan was performed on the patient to select a CT slice where the lesion could be observed; (II) the optimal puncture point was marked on the patient’s skin with a marker pen by drawing a horizontal line using positioning marks; (III) based on CT image measurement data, the surface guide point was marked on the patient’s skin, the desired positioning angle was set, and it was confirmed that the indicating laser was in the correct direction and angle; (IV) the laser localization system was moved on the track and the CT examination table was adjusted to make the laser accurately point to the surface guide point on the patient’s skin; (V) puncture was performed according to the surface guide point, with the end of the puncture needle overlapping the guide point. After inserting the needle to the predetermined depth, repeated CT scans were performed to check the position of the puncture needle and the lesion; (VI) after confirming the puncture position was correct, the needle core was pulled out and an appropriate amount of medical tissue adhesive (Kangpai Te, 0.5 mL/vial) was injected; (VII) after the puncture, repeated CT scans were performed to confirm no complications such as pneumothorax, hemorrhage, or pleural effusion.
Control group operation methods: (I–III) were the same as those in the observation group; (IV) to ensure the stability of the operation technique, a physician with associate senior title or above (independent operation experience ≥3 years, completed ≥50 lung nodule punctures in the past year) performed the operation. Based on personal clinical experience, puncture was performed at the surface guide point. After inserting the needle to the predetermined depth, repeated CT scans were performed to check the position of the puncture needle and the lesion; (V) after confirming the puncture position was correct, the needle core was pulled out and an appropriate amount of medical tissue adhesive was injected; (VI) after the puncture, repeated CT scans were performed to confirm no complications such as pneumothorax, hemorrhage, or pleural effusion. All puncture operations conducted in the two groups were implemented by identical medical staff to avoid operator-related bias.
Observation indicators
(I) One-time puncture to the predetermined position: calculated from the start of local anesthesia injection on the body surface; (II) puncture time: time from the start of local anesthesia injection on the body surface to puncture to the predetermined position; (III) difficulty of puncture: mild, moderate, severe; (IV) incidence of puncture complications: hemorrhage, pneumothorax, hemothorax (pleural effusion), cough, hemoptysis, etc.; (V) puncture success rate.
Statistical analysis
The parametric student’s t-test and nonparametric Mann-Whitney U-test were used to compare the differences between the two groups, and the Chi-squared test was performed for categorical variables. Continuous and categorical variables are presented as medians (interquartile ranges) and frequencies (percentages), respectively. All the statistical analyses were performed using Python (version 3.7.3). Statistical significance was defined as a two-sided P value <0.05.
Results
Clinical characteristics
Comparison of general data comparison of clinical baseline data between the two groups of patients with lung nodules (Table 1). The overall enrollment flow of this study is presented in Figure 1. In the observation group, 60 patients underwent puncture with the laser locator, including 31 males (51.7%) and 29 females (48.3%), aged 39–80 years with an average age of 62.1±10.7 years. The lung nodules had a diameter of 0.3–1.8 cm with an average diameter of 0.85±0.38 cm; 33 cases were in the right upper lobe, 1 case in the right middle lobe, 10 cases in the right lower lobe, 14 cases in the left upper lobe, and 2 cases in the left lower lobe (48 non-lower lobe cases and 12 lower lobe cases), with a puncture success rate of 100%. In the control group, 60 patients underwent conventional puncture, including 26 males (43.3%) and 34 females (56.7%), aged 22–85 years with an average age of 61.4±12.9 years. The lung nodules had a diameter of 0.4–1.6 cm with an average diameter of 0.87±0.31 cm; 16 cases were in the right upper lobe, 3 cases in the right middle lobe, 13 cases in the right lower lobe, 10 cases in the left upper lobe, and 18 cases in the left lower lobe (29 non-lower lobe cases and 31 lower lobe cases), with 56 successful punctures (4 patients failed due to complications during puncture). There were statistically significant differences between the observation group and the control group in lung nodule location, average number of CT scans, radiation dose, and puncture time (all P<0.05). Figure 3 shows the CT images of a representative patient with a pulmonary nodule.
Table 1. Comparison of clinical information and accuracy assessment of pulmonary nodules between the two groups.
| Factors | Observation group (n=60) | Control group (n=60) | χ2/t/Z | P |
|---|---|---|---|---|
| Sex | 0.835 | 0.365 | ||
| Female | 31 (51.7) | 26 (43.3) | ||
| Male | 29 (48.3) | 34 (56.7) | ||
| Age (years) | 62.1±10.7 | 61.4±12.9 | 0.331 | 0.741 |
| Location | – | <0.001 | ||
| RUL | 33 (55.0) | 16 (26.7) | ||
| RML | 1 (1.7) | 3 (5.0) | ||
| RLL | 10 (16.7) | 13 (21.7) | ||
| LUL | 14 (23.3) | 10 (16.6) | ||
| LLL | 2 (3.3) | 18 (30.0) | ||
| Nodule diameter (cm) | 0.85±0.38 | 0.87±0.31 | 0.752 | 0.452 |
| Average number of CT scans (times) | 3.53±1.40 | 5.80±1.56 | 57.204 | <0.001 |
| Radiation dose (mSv) | 45.81±12.41 | 65.28±15.16 | −7.700 | <0.001 |
| Needle insertion length (cm) | 6.90±1.71 | 6.64±1.71 | 0.796 | 0.428 |
| Puncture position | 0.539 | 0.467 | ||
| Supine | 35 (58.3) | 31 (51.7) | ||
| Prone | 25 (41.7) | 29 (48.3) | ||
| Puncture time (min) | 7.63±3.51 | 11.0±5.31 | 4.035 | <0.001 |
| Difficulty of puncture | 1.137 | 0.710 | ||
| Mild | 35 (58.3) | 39 (65.0) | ||
| Moderate | 17 (28.3) | 12 (20.8) | ||
| Severe | 8 (13.4) | 9 (15.0) | ||
| Hemorrhage | 4 (6.7) | 5 (8.3) | – | >0.999 |
| Pneumothorax | 1 (1.7) | 7 (11.7) | – | 0.061 |
| Hemothorax | 0 (0) | 1 (1.7) | – | >0.999 |
| Puncture success rate | 56 (93.3) | 50 (83.3) | – | 0.089 |
| One-time puncture to the predetermined position | 60 (100.0) | 56 (93.3) | – | 0.079 |
Data are presented as n (%) or mean ± standard deviation. CT, computed tomography; LLL, left lower lobe; LUL, left upper lobe; RLL, right lower lobe; RML, right middle lobe; RUL, right upper lobe.
Figure 3.
Representative CT images of the lung nodules. (A) Axial view, (B) coronal view, (C) sagittal view. A pure ground-glass nodule with clear borders, through which microvessels pass, is located in the anterior segment of the right upper lobe, adjacent to the right heart border. The red arrows indicate the pulmonary nodule. CT, computed tomography.
Comparison of pulmonary nodule puncture localization
Evaluation of puncture localization characteristics and accuracy in both groups complications were graded and described with reference to the Common Terminology Criteria for Adverse Events (CTCAE 5.0). In the observation group, 56 patients achieved one-time puncture to the predetermined position (93.3%); the average puncture time was 7.63±3.51 min; the difficulty of puncture was mild in 35 cases, moderate in 17 cases, and severe in 8 cases; the incidence of puncture complications was 8.3% (5/60), including 4 cases of hemorrhage (Grade 1, mainly blood-tinged sputum) and 1 case of pneumothorax (Grade 1, lung compression <15%). In the control group, 50 patients achieved one-time puncture to the predetermined position (83.3%); the average puncture time was 11.00±5.31 min; the difficulty of puncture was mild in 39 cases, moderate in 12 cases, and severe in 9 cases; the incidence of puncture complications was 21.7% (13/60), including 6 cases of hemorrhage [5 cases of blood-tinged sputum (Grade 1) and 1 case of moderate hemoptysis (Grade 2)] and 7 cases of pneumothorax (Grade 1–2, lung compression <30%); the one-time puncture success rate was 83.3%, and 4 patients failed due to complications (Table 1). Figure 4 illustrates the application of a laser localization system in assisting the puncture localization of pulmonary nodules.
Figure 4.
Workflow of CT-guided percutaneous lung nodule localization using the laser localization system. (A) Pre-procedural planning CT scan demonstrating the intended puncture path. (B) The laser navigation system integrated with the CT scanner. (C) Intraoperative real-time guidance using the laser navigation system. (D) Needle insertion at the skin entry point marked by laser guidance (the blue arrow indicates the puncture needle tip, which is precisely aligned with the laser targeting point). (E) Post-insertion confirmation CT scan showing the needle position within the target nodule. CT, computed tomography.
Subgroup analysis of pulmonary nodule location
Subgroup analysis of lung nodule locations in both groups to evaluate the impact of respiratory motion on puncture errors of nodules in different locations and the effectiveness of the laser locator, subgroup analysis was performed according to nodule location. Among them, 12 cases in the observation group and 31 cases in the control group had nodules located in the lower lobes (including right lower lobe and left lower lobe); 48 cases in the observation group and 29 cases in the control group had nodules located in non-lower lobes (including right upper lobe, right middle lobe, and left upper lobe). Subgroup analysis results showed that respiratory motion had a greater impact on lower lobe nodules. Within the observation group, the puncture error for lower lobe nodules was significantly greater than that for non-lower lobe nodules (2.48±0.65 vs. 1.90±0.31 mm, t=−2.432, P=0.023); within the control group, the puncture error for lower lobe nodules was also greater than that for non-lower lobe nodules (3.61±1.72 vs. 2.58±0.52 mm, t=−8.236, P<0.001) (Table 2).
Table 2. Comparison of puncture errors for nodules in different lung lobe positions between the observation group and the control group.
| Groups | Observation group (n=60) | Control group (n=60) | t | P |
|---|---|---|---|---|
| Lower lobe | 2.48±0.65 (n=12) | 3.61±1.72 (n=31) | −2.432 | 0.023 |
| Non-lower lobe nodules | 1.90±0.31 (n=48) | 2.58±0.52 (n=29) | −8.236 | <0.001 |
Data are presented as mean ± standard deviation unless otherwise stated.
Discussion
CT-guided percutaneous puncture localization has become a widely used method for the diagnosis and treatment of suspected malignant tumors due to its simplicity and effectiveness. However, inaccurate localization can increase the number of repeated scans, radiation dose, and incidence of complications. To address this issue, this study adopted a novel laser navigation locator-assisted system to improve puncture accuracy, reduce complications, and lower radiation dose. In this prospective clinical study, a total of 120 patients with lung nodules were randomly treated with the laser locator system or conventional puncture method. Compared with conventional puncture, the laser locator system showed reliability, practicality, and accuracy in puncture surgery.
Operator-related bias is an inevitable confounding factor in image-guided interventional procedures. Traditional CT-guided puncture relies heavily on the operator’s personal experience and subjective judgment, while laser localization provides visualized and standardized guidance, resulting in different operation modes between the two groups. In this study, all puncture procedures were performed by a unified team of senior radiologists with extensive experience in lung intervention, which ensured consistent operational proficiency and reduced inter-operator variability. In addition, all operators had long-term clinical training and accumulated sufficient practical experience, weakening the potential impact of the learning curve.
Focusing on procedural parameters is the primary exploratory objective of this study. Nevertheless, comprehensive clinical relevance should not be ignored. Accurate preoperative localization is closely associated with thoracic surgical outcomes. Reliable nodule marking can improve localization success during VATS, reduce surgical trauma and shorten operation time. In addition, optimized puncture accuracy helps obtain sufficient and qualified tissue samples, which is conducive to improving diagnostic yield and providing accurate pathological evidence for clinical diagnosis and treatment. Reasonable application of laser-assisted localization can further standardize interventional procedures and assist clinicians in formulating more reasonable treatment strategies. Related clinical outcomes will be systematically explored in our future large-sample studies.
This study confirmed that the laser locator system can not only guide the puncture needle from the skin to the target according to the pre-planned trajectory but also has the function of correcting the puncture point, allowing the operator to readjust the needle trajectory as needed. The laser locator uses advanced laser technology to achieve accurate lung nodule localization, with key technical parameters including angle error (±0.5°/10 cm) and positioning accuracy (average error ≤2 mm). Compared with traditional methods relying on the operator’s experience, it effectively overcomes the influence of human error and anatomical location, significantly improving puncture accuracy (16). Lung nodule puncture is susceptible to anatomical location, which increases puncture risk. During CT localization, visual errors and insufficient experience can reduce accuracy. In recent years, multiple advanced image-guided intervention techniques have been widely applied to improve the accuracy and safety of lung puncture, such as electromagnetic navigation, cone-beam CT guidance, and robotic-assisted puncture systems. For example, Zhang et al. (17) used electromagnetic navigation bronchoscopy to assist in the localization of multiple lung nodules in elderly patients. Electromagnetic navigation enables real-time needle tracking without continuous fluoroscopy, which reduces partial radiation exposure; however, it is susceptible to interference from metal instruments and surrounding magnetic field environment, and the overall cost of supporting equipment remains relatively high (18). Cone-beam CT guidance provides intraprocedural three-dimensional reconstructed images with high spatial resolution, allowing dynamic adjustment of puncture trajectories; nevertheless, repeated cone-beam scanning inevitably increases cumulative radiation dose, and the operation relies heavily on specialized equipment and professional technicians (19). Robotic-assisted puncture delivers superior stability and precise mechanical positioning, minimizing manual operation errors; however, the high procurement and maintenance costs, complicated workflow, and lengthy learning curve greatly restrict its large-scale promotion and routine clinical application, especially in primary medical institutions (2). In comparison, the laser locator used in this study offers unique complementary advantages, including simple operation, intuitive visual guidance, low equipment cost, freedom from magnetic interference and additional high-dose scanning, as well as easy handling, a short learning curve and favorable cost-effectiveness, making it a practical alternative worthy of further clinical investigation, particularly for primary care settings.
In the present study, the observation group achieved one-time puncture success in 93.3% of cases, compared with 83.3% in the control group; however, this difference did not reach statistical significance. Nevertheless, the laser locator was associated with a lower overall complication rate (8.3% vs. 21.7%), fewer CT scans, lower radiation dose, and shorter procedure time. In the control group, multiple needle adjustments were more frequent, and four patients experienced procedure failure due to complications. Previous studies have pointed out that 94% of traditional CT-guided punctures require multiple adjustments, mainly relying on the operator’s experience to judge the needle insertion angle and depth, which is likely to cause patient discomfort and increase the risk of complications and radiation exposure (20,21). This study confirmed that the laser locator can effectively improve puncture stability. In response to the impact of respiratory motion (especially for lower lobe lesions), preoperative respiratory training significantly reduced postural deviations. Compared with traditional methods, the laser locator reduces puncture errors, decreases complications, and improves biopsy success rate through high-precision calibration. Subgroup analysis showed that although the puncture error in the lower lobe group was greater than that in the non-lower lobe group, the positive effect of the laser locator in the lower lobe group was more significant, further confirming the clinical value of the laser locator in respiratory-sensitive areas (such as the lower lobes). In addition to puncture accuracy, the radiation dose received by patients is a crucial consideration (22,23). Despite the continuous improvement of CT imaging equipment and scanning technology, which have been used in various clinical interventional procedures, CT radiation dose remains a major concern for doctors and patients (24). Komaki et al. (25) pointed out that an increase in the number of needle adjustments during puncture can improve puncture accuracy, but repeated CT scans will increase radiation dose; previous studies have also shown that the use of robot-assisted navigation systems is associated with reduced postoperative complications, shorter operation duration, and reduced radiation exposure (26). In this study, compared with the control group, the observation group had significantly fewer CT scans (3.53±1.40 vs. 5.80±1.56 times), and the radiation dose was correspondingly lower (45.81±12.41 vs. 65.28±15.16 mSv). It can be seen that the use of the laser locator system not only reduces lung damage caused by repeated CT scans but also significantly shortens the puncture time without affecting puncture accuracy, enabling successful puncture to the target position. Moreover, patients receive significantly less radiation dose when using this system. Therefore, the laser locator system helps improve puncture success rate and reduce complications.
Selecting an appropriate positioning marker is crucial for lung nodule localization and surgery. The commonly used Hook-wire localization involves percutaneous puncture of a trocar into the lung, advancing 3–5 mm after CT confirmation of the position, releasing the metal wire, and expanding the metal hook to fix the nodule. However, it has risks of complications such as pneumothorax, wire displacement, and even air embolism (27-30). Microcoil localization is similar to Hook-wire in operation; after needle insertion and localization, the microcoil is released and fixed by friction. However, it has problems such as displacement, pneumothorax, and hemorrhage, which increase surgical difficulty (31-33). Methylene blue (MB) injection localization is widely used with a high success rate, but pigment deposition on the lung surface affects nodule identification, and specimen staining interferes with pathological evaluation, resulting in significant limitations (34,35). In contrast, this study used medical tissue adhesive as a positioning marker, which polymerizes and solidifies in blood and tissue fluid to occlude blood vessels, stop bleeding, and enhance visibility, permeability, and pathological compatibility, making it a valuable tool for improving the accuracy and safety of surgical operations.
This study has several limitations. First, although standardized simple randomization was performed, notable baseline imbalance was still observed, especially the uneven distribution of pulmonary nodules in the upper and lower lobes between the two groups. Variations in respiratory motion across different lung lobes may affect procedural difficulty and puncture outcomes, thereby introducing potential confounding bias. Second, this was a single-center prospective trial with a relatively limited sample size. Further large-scale and rigorously designed randomized controlled trials are essential to validate the accuracy, safety and clinical efficacy of this laser localization technique. Third, inconsistent respiratory amplitude and frequency among patients may compromise laser-assisted positioning. Inadequate patient cooperation can cause intraoperative displacement of pulmonary nodules, which may impair the overall localization precision during puncture. Additionally, this study lacked long-term follow-up regarding surgical resection accuracy and patient prognostic outcomes. Collectively, the results of the present study should be considered preliminary. Well-designed, multicenter investigations with larger cohorts and comprehensive statistical adjustment are warranted to confirm the general applicability and sustained clinical value of laser locator-assisted CT-guided puncture.
Conclusions
In summary, this preliminary study suggests that laser locator-assisted puncture is associated with favorable procedural outcomes, including reduced radiation exposure, fewer complications, and shorter procedure time. Although the between-group difference in one-time puncture success rate was not statistically significant, the overall findings support the potential value of this system and generate hypotheses for future prospective controlled trials. Further large-scale, multicenter studies are needed to confirm its efficacy, define its optimal indications, and clarify its role in routine clinical practice.
Supplementary
The article’s supplementary files as
Acknowledgments
We sincerely thank Shangrao Aoruidi Medical Technology Co., Ltd., China, for providing the laser localization system and technical support used in this study.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Ethics Committee of The Eighth Affiliated Hospital of Southern Medical University (The First People’s Hospital of Shunde) (No. KYLS20231056), and written informed consent was acquired from all enrolled participants prior to enrollment.
Footnotes
Reporting Checklist: The authors have completed the CONSORT reporting checklist. Available at https://qims.amegroups.com/article/view/10.21037/qims-2026-1-0404/rc
Trial Protocol: Available at https://qims.amegroups.com/article/view/10.21037/qims-2026-1-0404/tp
Funding: The study was supported by the grants of the Guangdong Medical Science and Technology Research Fund (grant Nos. A2024112 and A2024022); Research Launch Project of Shunde Hospital of Southern Medical University (grant Nos. SRSP2023003, SRSP2024013 and SRSP2024032); The Science and Technology Planning Project of Foshan (grant Nos. 2320001006640 and 2220001005383); and Southern Medical University Image Alliance Research Fund Project (grant No. FS202402016).
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-2026-1-0404/coif). The authors have no conflicts of interest to declare.
Data Sharing Statement
Available at https://qims.amegroups.com/article/view/10.21037/qims-2026-1-0404/dss
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