title: Thoracoscopic wedge lung resection using virtual-assisted lung mapping.
abstract: BACKGROUND
  Virtual-assisted lung mapping is a novel bronchoscopic preoperative lung marking technique using virtual images to conduct multiple concurrent lung markings with dye. This study analyzed the indications, mapping design, and outcomes of lung wedge resection using virtual-assisted lung mapping.
  
  
  METHODS
  From August 2012 to October 2013, 35 patients with 59 lesions were planned to undergo thoracoscopic lung wedge resection aided by virtual-assisted lung mapping. The data related to virtual-assisted lung mapping were prospectively collected, with the exception of the mapping design which was retrospectively analyzed.
  
  
  RESULTS
  Suspected primary lung cancer (21 lesions in 18 patients) and metastatic lung tumors (38 lesions in 17 patients) were treated by thoracoscopic lung wedge resection with the aid of virtual-assisted lung mapping; 50 wedge resections were conducted with 107 markings. Virtual-assisted lung mapping was most frequently designed to place 2 (n = 15 wedge resections) or 3 (n = 17) markings to both identify the tumor(s) and secure a sufficient resection margin. In 7 wedge resections, anatomical landmarks and/or imaginary auxiliary lines functioned as complementary parts of the lung map when bronchial anatomy did not allow for markings at ideal spots. The resection outcomes were satisfactory without clinically evident complications.
  
  
  CONCLUSIONS
  Multiple markings of virtual-assisted lung mapping not only enabled tumor identification, but also secured sufficient resection margins. Special techniques using anatomical landmarks and imaginary auxiliary lines were complementary to the lung map when bronchial anatomy did not allow for markings at ideal spots.
authors.affiliation: Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan satomasa@kuhp.kyoto-u.ac.jp.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Sato
authors.affiliation: Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Aoyama
authors.affiliation: Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Toshi
authors.initials: T
authors.lastname: Menjyu
authors.affiliation: Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Fengshi
authors.initials: F
authors.lastname: Chen
authors.affiliation: Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Sonobe
authors.affiliation: Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Mitsugu
authors.initials: M
authors.lastname: Omasa
authors.affiliation: Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Date
mesh_terms: D000368:Aged; D059925:Anatomic Landmarks; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007564:Japan; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Bronchoscopy; Fluoroscopy; Lung neoplasms; Staining and labeling; Thoracic surgery; Video-assisted thoracic surgery (VATS)