Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan.
Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
J Thorac Cardiovasc Surg. 2022 Jul;164(1):243-251.e5. doi: 10.1016/j.jtcvs.2021.09.016. Epub 2021 Sep 17.
Virtual-assisted lung mapping 2.0 is a novel preoperative bronchoscopic lung mapping technique combining the multiple dye marks of conventional virtual-assisted lung mapping with intrabronchial microcoils to navigate thoracoscopic deep lung resection. This study's purpose was to evaluate the feasibility of virtual-assisted lung mapping 2.0 in resecting deeply located pulmonary nodules with adequate margins.
A multicenter, prospective single-arm study was performed from 2019 to 2020 in 8 institutions. The selection criteria were barely identifiable nodules requiring sublobar lung resections, nodules requiring resection lines reaching the inner 2/3 of the pulmonary lobe on computed tomography images in wedge resection, or the nodule center located in the inner 2/3 of the pulmonary lobe in wedge resection or segmentectomy. Resection margins larger than 2 cm or the nodule diameter were considered successful resection. Bronchoscopic placement of multiple dye marks and microcoil(s) was conducted 0 to 2 days before surgery.
We analyzed 65 lesions in 64 patients. The diameter and depth of the targeted nodules and the minimum required resection depth reported as median (interquartile range) were 9 (7-13) mm, 11 (5-15) mm, and 30 (25-35) mm, respectively. Among 60 wedge resections and 5 segmentectomies, successful resection was achieved in 64 of 65 resections (98.5%; 95% confidence interval, 91.7-100). Among 75 microcoils placed, 3 showed major displacement after bronchoscopic placement. There were no severe adverse events associated with the virtual-assisted lung mapping procedure.
This study demonstrated that virtual-assisted lung mapping 2.0 can facilitate successful resections for deep pulmonary nodules, overcoming the limitations of conventional virtual-assisted lung mapping.
虚拟辅助肺 2.0 规划是一种新型术前支气管镜肺规划技术，它结合了传统虚拟辅助肺规划的多个染料标记与支气管内微线圈，以引导胸腔镜下的深肺切除术。本研究旨在评估虚拟辅助肺 2.0 规划在切取具有足够切缘的深位肺部结节中的可行性。
2019 年至 2020 年，在 8 家机构进行了一项多中心、前瞻性、单臂研究。入选标准为需要亚肺叶切除术的难以辨认的结节、楔形切除术时需要切除线达到 CT 图像上肺叶内 2/3 的结节，或楔形切除术或节段切除术时结节中心位于肺叶内 2/3 处的结节。切除边缘大于 2cm 或结节直径被认为是成功切除。在手术前 0 至 2 天进行多个染料标记和微线圈的支气管镜放置。
我们分析了 64 例患者的 65 个病灶。目标结节的直径和深度以及报告的最小需要切除深度的中位数（四分位间距）分别为 9（7-13）mm、11（5-15）mm 和 30（25-35）mm。在 60 例楔形切除术和 5 例节段切除术中有 64 例（98.5%；95%置信区间，91.7-100）达到了成功切除。在放置的 75 个微线圈中，有 3 个在支气管镜放置后出现了明显的移位。虚拟辅助肺规划过程中没有发生严重的不良事件。
本研究表明，虚拟辅助肺 2.0 规划可以促进深位肺部结节的成功切除，克服了传统虚拟辅助肺规划的局限性。
