title: Safety and reproducibility of virtual-assisted lung mapping: a multicentre study in Japan.
abstract: OBJECTIVE
  Virtual-assisted lung mapping (VAL-MAP) is a preoperative bronchoscopic multispot dye-marking technique using virtual images. The purpose of this study was to evaluate the safety, efficacy and reproducibility of VAL-MAP among multiple centres.
  
  
  METHODS
  Selection criteria included patients with pulmonary lesions anticipated to be difficult to identify at thoracoscopy and/or those undergoing sub-lobar lung resections requiring careful determination of resection margins. Data were collected prospectively and, if needed, compared between the centre that originally developed VAL-MAP and 16 other centres.
  
  
  RESULTS
  Five hundred patients underwent VAL-MAP with 1781 markings (3.6 ± 1.2 marks/patient). Complications associated with VAL-MAP necessitating additional management occurred in four patients (0.8%) including pneumonia, fever and temporary exacerbation of pre-existing cerebral ischaemia. Minor complications included pneumothorax (3.6%), pneumomediastinum (1.2%) and alveolar haemorrhage (1.2%), with similar incidences between the original centre and other centres. Marks were identifiable during operation in approximately 90%, whereas the successful resection rate was approximately 99% in both groups, partly due to the mutually complementary marks. The contribution of VAL-MAP to surgical success was highly rated by surgeons resecting pure ground glass nodules ( P  < 0.0001), tumours ≤ 5 mm ( P  = 0.0016), and performing complex segmentectomy and wedge resection ( P  = 0.0072).
  
  
  CONCLUSIONS
  VAL-MAP was found to be safe and reproducible among multiple centres with variable settings. Patients with pure ground glass nodules, small tumours and resections beyond conventional anatomical boundaries are considered the best candidates for VAL-MAP.
  
  
  BACKGROUND
  UMIN 000008031. University Hospital Medical Information Network Clinical Trial Registry ( http://www.umin.ac.jp/ctr/ ).
authors.affiliation: Department of Thoracic Surgery, Kyoto University, Kyoto, Japan.|Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Sato
authors.affiliation: The Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushyu, Japan.
authors.forename: Taiji
authors.initials: T
authors.lastname: Kuwata
authors.affiliation: Department of Thoracic Surgery, Kitano Hospital, Osaka, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Yamanashi
authors.affiliation: Department of Respiratory Medicine, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kitamura
authors.affiliation: Department of Thoracic Surgery, Aizawa Hospital, Matsumoto, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Misawa
authors.affiliation: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Kota
authors.initials: K
authors.lastname: Imashimizu
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Thoracic Surgery, Nagara Medical Center, Gifu, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Ikeda
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Terumoto
authors.initials: T
authors.lastname: Koike
authors.affiliation: Department of Thoracic Surgery, Shimane Prefectural Central Hospital, Izumo, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Kosaka
authors.affiliation: Department of Thoracic Surgery, Shonan Kamakura General Hospital, Kamakura, Japan.
authors.forename: Ryuta
authors.initials: R
authors.lastname: Fukai
authors.affiliation: Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sekine
authors.affiliation: Department of Thoracic Surgery, Matsue Red Cross Hospital, Matsue, Japan.
authors.forename: Noritaka
authors.initials: N
authors.lastname: Isowa
authors.affiliation: Department of Surgery, Okayama Rosai Hospital, Okayama, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Hirayama
authors.affiliation: Department of Thoracic Surgery, Hygo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sakai
authors.affiliation: Department of Thoracic Surgery, Matsusaka City Hospital, Matsusaka, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Watanabe
authors.affiliation: Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nagayama
authors.affiliation: Department of Thoracic Surgery, Kyoto University, Kyoto, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Aoyama
authors.affiliation: Department of Thoracic Surgery, Kyoto University, Kyoto, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Date
authors.affiliation: Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Nakajima
mesh_terms: D000368:Aged; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007564:Japan; D008168:Lung / Q000000981:diagnostic imaging* / Q000601:surgery; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011013:Pneumonectomy; D011300:Preoperative Care / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D015203:Reproducibility of Results
keywords: Ground glass opacity ; Lung cancer ; Marking ; Metastatic pulmonary tumour ; Segmentectomy