Abstract: Objective To compare the feasibility and safety of Hookwire and methylene blue combined with indocyanine green (MB＆ICG)for the preoperative localization of pulmonary nodule (PN) in the elderly, and to explore the risk factors for common complications. Methods A retrospective analysis was conducted on the clinical data of 88 elderly patients who underwent preoperative localization of PN before video-assistant thoracoscopic surgery (VATS) at Nanjing Drum Tower Hospital from January to May 2023. The patients were divided into Hookwire group (n=50) and MB＆ICG group (n=38) group according to preoperative localization methods. General clinical data, operative data, localization effect and related complications of the two groups were compared. Multivariate Logistic regression was used to analyze the risk factors of common complications. Results No deaths or serious complications occurred during localization. Compared with MB＆ICG group, Hookwire group had higher incidence rate of pneumothorax, higher pain score and shorter positioning time (P<0.05). There was no significant difference in the localization success rate between the two groups (P>0.05). Multivariate Logistic regression analysis showed that location mode was an independent risk factor for pneumothorax (OR=17.708, 95%CI: 3.481-90.085, P<0.05). Conclusions Hookwire and MB ＆ICG under CT guidance had achieved good results in preoperative localization of PN in the elderly. Although the localization time of MB＆ICG was longer, the patients have a lower incidence of pneumothorax and less pain.

Key words: methylene blue, indocyanine green, preoperative localization, thoracoscopic surgery, aged