CT-guided microwave ablation combined with thoracoscopic resection for multiple ground-glass nodules: a single-session treatment strategy

Purpose To explore the safety, feasibility and clinical value of CT-guided microwave ablation (MWA) combined with immediate uniportal video-assisted thoracoscopic surgery (Uni-VATS) in the treatment of multiple pulmonary ground-glass nodules (GGNs). Methods The clinical, radiographic, surgical, and pathological data of patients with multiple GGNs who underwent CT-guided MWA combined with Uni-VATS from October 2022 to December 2024 were retrospectively reviewed. Results A total of 31 patients (7 males, 24 females; mean age 59.3 ± 9.5 years) with multiple GGNs underwent CT-guided MWA combined with Uni-VATS. Among these patients, 78 lesions were treated: 32 with MWA and 46 with surgical resection. The mean nodule size of the ablated lesions was 7.4 mm, while the mean nodule size of the resected lesions was 12.2 mm. Postoperative complications occurred in one patient (pneumothorax and subcutaneous emphysema), which resolved with symptomatic treatment before discharge. The technical success rate and clinical efficacy of CT-guided microwave ablation were 100%, with no severe complications or procedure-related mortality. During follow-up, no local recurrence or metastatic progression was observed. Conclusion Our preliminary experience suggests that a single-session, combined approach of CT-guided MWA immediately followed by Uni-VATS for the treatment of multiple GGNs is safe and feasible, and may provide an alternative treatment method for more patients, especially those who cannot tolerate the simultaneous removal of multiple nodules.