Virtual-assisted lung mapping: outcome of 100 consecutive cases in a single institute.

OBJECTIVES We developed virtual-assisted lung mapping (VAL-MAP), a bronchoscopic multispot dye-marking technique using three dimensional (3D) virtual imaging, for precise thoracoscopic sublobar lung resection with safe surgical margins. We herein review the results of 100 consecutive cases of VAL-MAP in our institute to identify types of tumours or resections that benefit from VAL-MAP. METHODS Markings were bronchoscopically made within 2 days preoperatively using virtual 3D images. Post-VAL-MAP computer tomography (CT) scans localizing the actual markings were reconstructed into 3D images for intraoperative navigation. All data on patients, markings and outcomes were prospectively collected, and the contribution of VAL-MAP to the operation was graded by the surgeon. RESULTS Resections of 156 lung lesions in 100 consecutive patients were planned from July 2012 to March 2014. The lesion diameter was 8.3 ± 4.9 (range, 2-24) mm. The total number of actually conducted markings was 380 (3.83 ± 1.07 markings/patient). Eighty-four lesions were resected by 71 wedge resections using 158 markings (2.1 ± 0.1/resection; range, 1-3). Seventy lesions were resected by 63 segmentectomies using 224 markings (3.6 ± 0.1/resection; range, 2-6). Markings were identifiable on post-VAL-MAP CT mostly as ground-glass opacities (87.7%) and/or bronchial dilatation (56.1%). During the operation, 357 of 380 markings (93.9%) were visible on the pleural surface and significantly associated with marking visibility on CT. Multiple markings that were complementary to one another appeared to have contributed to the high rate of successful resection (99.3%) with satisfactory resection margins. The contribution of VAL-MAP to the operation as graded by surgeons demonstrated that VAL-MAP is most effective during wedge resection or complex segmentectomy for hardly palpable, small tumours, while VAL-MAP still plays an important role in simple segmentectomy or resection of palpable tumours by providing higher confidence levels to surgeons during the operation. Minor pneumothoraces were found on post-VAL-MAP CT images in 4 patients without symptoms or a need for treatment. CONCLUSIONS The present study further demonstrated the efficacy and safety of VAL-MAP. VAL-MAP is likely to benefit a broader range of patients than are conventional marking techniques by assisting with both accurate tumour identification and precise determination of resection lines.

[1]  今井紗智子,et al.  Virtual Assisted Lung Mapping(VAL‐MAP)法による術前マーキングの有用性 , 2017 .

[2]  M. Sonobe,et al.  Thoracoscopic wedge lung resection using virtual-assisted lung mapping , 2015, Asian cardiovascular & thoracic annals.

[3]  Toshihiko Sato,et al.  Use of virtual assisted lung mapping (VAL-MAP), a bronchoscopic multispot dye-marking technique using virtual images, for precise navigation of thoracoscopic sublobar lung resection. , 2014, The Journal of thoracic and cardiovascular surgery.

[4]  S. Cattaneo,et al.  Thoracoscopic detection of occult indeterminate pulmonary nodules using bronchoscopic pleural dye marking , 2014, Journal of community hospital internal medicine perspectives.

[5]  A. Dirksen,et al.  CT screening for lung cancer brings forward early disease. The randomised Danish Lung Cancer Screening Trial: status after five annual screening rounds with low-dose CT , 2012, Thorax.

[6]  S. Kanazawa,et al.  Systemic air embolism during preoperative pulmonary marking with a short hook wire and suture system under CT fluoroscopy guidance , 2009, Japanese Journal of Radiology.

[7]  S. Toyooka,et al.  Clinical outcomes of short hook wire and suture marking system in thoracoscopic resection for pulmonary nodules. , 2009, European Journal of Cardio-Thoracic Surgery.

[8]  C. Feo,et al.  Intrathoracoscopic localization techniques. Review of literature. , 2006, Surgical endoscopy.

[9]  C. Feo,et al.  Intrathoracoscopic localization techniques , 2006, Surgical Endoscopy And Other Interventional Techniques.

[10]  Y. Iwasaki,et al.  Fluoroscopy-guided barium marking for localizing small pulmonary lesions before video-assisted thoracic surgery. , 2005, Respiratory medicine.

[11]  Yoichiro Ishihara,et al.  Ultrathin bronchoscopic barium marking with virtual bronchoscopic navigation for fluoroscopy-assisted thoracoscopic surgery. , 2004, Chest.

[12]  T. Sakamoto,et al.  CT fluoroscopy-guided bronchoscopic dye marking for resection of small peripheral pulmonary nodules. , 2004, Chest.

[13]  K. Kondo,et al.  Fatal air embolism during computed tomography-guided pulmonary marking with a hook-type marker. , 2003, The Journal of thoracic and cardiovascular surgery.

[14]  N. Shimizu,et al.  Preoperative localization of small pulmonary lesions with a short hook wire and suture system: experience with 168 procedures. , 2002, Radiology.

[15]  T. Naruke,et al.  Fluoroscopy-assisted thoracoscopic resection of lung nodules marked with lipiodol. , 2002, The Annals of thoracic surgery.

[16]  Thomas A Horan,et al.  Massive gas embolism during pulmonary nodule hook wire localization. , 2002, The Annals of thoracic surgery.

[17]  H. Wada,et al.  A new method of segmental resection for primary lung cancer: intermediate results. , 2002, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[18]  Y. Morishita,et al.  Cerebral arterial air embolism following CT-guided lung needle marking. Report of a case. , 2001, The Journal of cardiovascular surgery.

[19]  N. Tsubota,et al.  Ongoing prospective study of segmentectomy for small lung tumors. Study Group of Extended Segmentectomy for Small Lung Tumor. , 1998, The Annals of thoracic surgery.