title: Emphysematous lungs do not affect visibility of virtual-assisted lung mapping.
abstract: BACKGROUND
  It has recently been suggested that virtual-assisted lung mapping may enable safer and more reliable intraoperative navigation compared to conventional preoperative lung marking strategies. This study aimed to examine the relationship between emphysematous lungs and the intraoperative visibility of virtual-assisted lung mapping markings.
  
  
  METHODS
  We retrospectively analyzed the data of 21 patients who underwent virtual-assisted lung mapping followed by lung resection between October 2013 and May 2015. The visibility of the intraoperative lung markings was graded. The degree of pulmonary emphysema was assessed by the percentage of low attenuation area on computed tomography. We elucidated the associations between the marking grade and other factors such as patient age or sex, pulmonary lobe mapped, marking operator, Brinkman index, and percentage of low attenuation area of the pulmonary lobe.
  
  
  RESULTS
  In Spearman rank correlation analysis, there was no correlation between the Brinkman index and the percentage of low attenuation area (n = 26, r = -0.016, p = 0.937). In stepwise multivariate regression analysis, the marking grade correlated with the marking operator (p < 0.001) and the Brinkman index (p = 0.008), but not with patient age or sex, the pulmonary lobe mapped, or degree of pulmonary emphysema.
  
  
  CONCLUSIONS
  The skill of the marking operator and the patient's smoking history had significant effects on the intraoperative visibility of markings made by virtual-assisted lung mapping, whereas emphysematous lungs did not affect the intraoperative visibility of lung markings.
authors.affiliation: Respiratory Disease Center, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Yamanashi
authors.affiliation: Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan satomasa@kuhp.kyoto-u.ac.jp.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Sato
authors.affiliation: Respiratory Disease Center, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Marumo
authors.affiliation: Respiratory Disease Center, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Japan.
authors.forename: Takamasa
authors.initials: T
authors.lastname: Fukui
authors.affiliation: Respiratory Disease Center, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Sumitomo
authors.affiliation: Department of Thoracic Surgery, Japanese Red Cross Otsu Hospital, Shiga, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Shoji
authors.affiliation: Respiratory Disease Center, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Otake
authors.affiliation: Faculty of Health Sciences, Department of Medical Engineering, Himeji Dokkyo University, Himeji, Hyogo, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Katayama
authors.affiliation: Respiratory Disease Center, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Japan.
authors.forename: Cheng-Long
authors.initials: CL
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks; D001999:Bronchoscopy; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011013:Pneumonectomy; D011237:Predictive Value of Tests; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D014741:Video Recording
keywords: Anatomic landmarks; Bronchoscopy; Lung neoplasms; Pneumonectomy; Pulmonary emphysema; Smoking