Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taiwan; Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Taiwan.
Asian J Surg. 2019 Mar;42(3):488-494. doi: 10.1016/j.asjsur.2018.06.005. Epub 2018 Jul 20.
BACKGROUND/OBJECTIVE: Virtual assisted lung mapping (VAL-MAP) is a bronchoscopic lung marking technique developed to assist in navigational lung resection. It can be used for nodule localization and segmental identification. This article presents our initial experience of thoracoscopic pulmonary segmentectomy using combined VAL-MAP and computed tomography (CT)-guided localization.
Markings with India Ink were made bronchoscopically, before surgery, using a virtual bronchoscopy system (LungPoint® Planner) without fluoroscopy guidance. Post VAL-MAP CT scans localized the actual markings. All data on patients, markings, and outcomes were retrospectively collected, and the contribution of VAL-MAP to the operation was graded by the surgeon.
From March 2017 to September 2017, 24 consecutive patients received the VAL-MAP marking procedure before thoracoscopic segmentectomy. Nineteen patients also received pre-operative CT-guided percutaneous localization after VAL-MAP; fifteen patients received CT-guided localization with dye (patent blue V) and microcoil, and four patients received with dye only. Of the 101 marking attempts made in all the patients, 71 (70.3%) were identified as contributing to the surgery. No clinically evident complications were associated with the procedure. A total of 24 segmentectomies were thoracoscopically conducted for 18 cases of lung cancer and six cases of benign diseases.
The combination of VAL-MAP and CT-guided percutaneous localization contribute to precise thoracoscopic pulmonary segmentectomy.
背景/目的：虚拟辅助肺图（VAL-MAP）是一种支气管镜下的肺标记技术，旨在辅助导航性肺切除术。它可用于结节定位和节段识别。本文介绍了我们使用联合 VAL-MAP 和 CT 引导定位进行胸腔镜肺段切除术的初步经验。
术前使用虚拟支气管镜系统（LungPoint® Planner）在无透视引导下经支气管进行印度墨水分步标记。VAL-MAP 后行 CT 扫描定位实际标记。回顾性收集所有患者、标记和结果的数据，并由外科医生对 VAL-MAP 对手术的贡献进行评分。
2017 年 3 月至 2017 年 9 月，24 例连续患者在胸腔镜肺段切除术前接受了 VAL-MAP 标记。19 例患者在 VAL-MAP 后还接受了术前 CT 引导下经皮定位；15 例患者接受了 CT 引导下染料（专利蓝 V）和微线圈定位，4 例患者仅接受了染料定位。在所有患者的 101 次标记尝试中，71 次（70.3%）被认为对手术有贡献。该操作未发生任何明显的临床并发症。共为 18 例肺癌和 6 例良性疾病患者进行了 24 例胸腔镜肺段切除术。
VAL-MAP 与 CT 引导下经皮定位相结合有助于实现精确的胸腔镜肺段切除术。
