Virtual-Assisted Lung Mapping 2.0: Preoperative Bronchoscopic Three-Dimensional Lung Mapping

Abstract

To better determine suitable resection lines for sublobar lung resection, especially to obtain sufficient resection depth, a novel technique of virtual-assisted lung mapping (VAL-MAP) 2.0 was developed by combining multispot dye marks (conventional VAL-MAP) and a deeply placed microcoil. With the patient under local anesthesia and sedation, multiple dye marks were bronchoscopically made on the lung surface. Microcoils were then bronchoscopically placed centrally to the tumor to indicate deep resection margins. Postmapping computed tomography confirmed the marking locations. Six patients underwent VAL-MAP 2.0: 5 for wedge resection and 1 for segmentectomy. The mean diameter and depth of the targeted lesions were 10.0 ± 4.1 and 12.6 ± 10.3 mm, respectively. In total, 18 dye marks and 9 microcoils were placed without major complications. The microcoils were successfully identified with intraoperative fluoroscopy, effectively assisting the surgeons' decision regarding the deep resection lines. This study confirmed the safety and feasibility of VAL-MAP 2.0. This technique effectively assisted surgeons to obtain sufficient resection margins in sublobar lung resection, even when removing deeply located lesions.