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.
OBJECTIVE
We have developed a novel bronchoscopic multiple marking technique to assist resection of hardly palpable lung tumors. Because 3-dimensional virtual images were used and multiple markings made on the lung surface to provide "geometric" information, we termed this technique "virtual assisted lung mapping" (VAL-MAP). The safety and efficacy of VAL-MAP were evaluated.


METHODS
Virtual bronchoscopy was used to select 2 to 4 appropriate bronchial branches for marking. Bronchoscopy was conducted with the patient under local anesthesia. A metal-tip catheter was inserted into a selected bronchus and advanced to the pleura. The location of the catheter tip was fluoroscopically confirmed, and 1 mL of indigo carmine was injected. This procedure was repeated to complete all the planned markings. Post-VAL-MAP computed tomography was used to visualize the localization of the multiple markings on 3-dimensional virtual images, which were used as references in the subsequent operation.


RESULTS
Of the 95 marking attempts made for 37 tumors in 30 patients, 88 (92.6%) were identified and contributed to the surgery. No clinically evident complications were associated with the procedure. A total of 15 wedge resections and 18 segmentectomies were thoracoscopically conducted, with a successful resection rate of 100%. Multiple markings of the VAL-MAP were complementary, enabling us to achieve complete resection even when 1 of the markings failed. The markings were visible even on interlobar fissures, at the apex, and on the diaphragm, which conventional percutaneous marking can hardly reach.


CONCLUSIONS
VAL-MAP was safely conducted with satisfactory outcomes in our early experience. Additional confirmation of its safety and efficacy is necessary.
Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan. Electronic address: satomasa@kuhp.kyoto-u.ac.jp.
Masaaki
M
Sato
Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
Mitsugu
M
Omasa
Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
Fengshi
F
Chen
Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
Toshihiko
T
Sato
Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
Makoto
M
Sonobe
Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
Toru
T
Bando
Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
Hiroshi
H
Date
D000368:Aged; D001999:Bronchoscopy / Q000009:adverse effects; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007203:Indigo Carmine; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011237:Predictive Value of Tests; D025321:Surgery, Computer-Assisted / Q000009:adverse effects; D013906:Thoracoscopy / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden
D004396:Coloring Agents; D007203:Indigo Carmine