Presenter: Dr. Yojiro Yutaka Dr Anthony W. Kim (Los Angeles, Calif). I congratulate Dr Yutaka and his colleagues at Kyoto and Fukuoka Universities for expanding on their innovative and pioneering work using radio frequency identification (RFID) technology to enhance the care of patients with challenging-to-locate lung lesions, an issue that we all encounter on occasion. Their ongoing work is undoubtedly worthy of continued praise, as evidenced from today's outstanding presentation. Having used multiple different localization techniques myself, I believe the solution that our colleagues from Kyoto and Fukuoka have been using is quite clever. The deployment of an RFID microchip bronchoscopically appears to be associated with several advantages, including but not limited to eliminating the dimension of time into their algorithm. I would imagine that using this chip lowers the burden of concern regarding the dissipation, spread, or loss of several chemical markers that have been espoused before. Furthermore, it eliminates the need to employ other adjuncts such as the need for fluoroscopic guidance or the reliance on our colleagues from other specialties to place other fiducial markers. All of these obvious advantages plus other advantages that I have omitted beg the question of what potential disadvantages do they consider when embarking on the use of this technology? More specifically, although they did not report any dislodgement of the RFID microchip, how are they prepared to handle this problem in real time if it had occurred, and in that same spirit, how were these RFID microchips affixed to the bronchial wall? The actual mechanics of the RFID chip deployment is unclear and so could the authors expand on this process? Secondly, some would argue that with other adjuncts such as 3-dimensional imaging or modeling or slightly more sophisticated planning, a segmentectomy can be performed without any localization process. Can they speak to how their technique is uniquely better over these other adjuncts? My final question pertains to the fact that their study is 1 of feasibility, but nearly half of their patients underwent only a wedge resection. Can they provide some patient and pathologic data as well as other justification as to why anatomic resections were not pursued, especially among the lesions that were considered malignant? The purpose of this question is multifold, but can be distilled down to the issue that if some of these resected lesions were more indolent in nature, as some pure ground-glass lesions tend to be, could one argue for observation alone? Can they provide any insight in this regard? Once again, I congratulate Dr Yutaka, and the other innovators from Kyoto and Fukuoka, Japan. We as a collective continue to look forward to the further advances by this group, who have established themselves as a forerunner in blazing new pathways in localization techniques. Dr Yojiro Yutaka (Kyoto, Japan). Thank you. I appreciate your valuable comments regarding this wireless marking technique. You asked about the potential disadvantages of using this technology. As you pointed out, RFID markers need to be removed with the tumor. In the current study, to minimize the risk of preoperative dislodgement of RFID markers, we conducted all procedures from the marker placement to surgery in the same series. When intraoperative dislodgement of the RFID marker occurs and it drops off to the central airway, intraoperative fluoroscopy will be required to check its location, and removal of the bronchoscope will be required. In the current study, there were no adverse effects regarding intraoperative dislodgment. However, the number of the RFID markings was so small; reliable data are not yet available. We have to correct data regarding dislodgment of RFID markers in the near future. You also asked about the mechanism of the fixation. RFID markers were equipped with nitinol coil anchor, whose diameter was 5 mm. The coil extended from the tip of the delivery device and the strength of its expansion allows to fix the RFID microchip to the bronchial wall. Next, as you mentioned, thoracic surgeons know that segmentectomy can be performed without any localization techniques. However, determination of the adequate rejection margin requires experienced surgical skills based on knowledge of pulmonary artery and correlation of preoperative imaging with intraoperative dissection. Particularly in segmentectomy for ground glass opacity lesions, located near the intersegmental vein, the cutting right line for securing adequate surgical margins is expected to be beyond the affected segment. For example, the use of indocyanine green can demarcate the intersegmental vein during segmentectomy, according to the intrapulmonary blood flow. However, emphysematous lung sometimes hampers adequate visualization in demarcating the intersegmental plane. For secure surgical margins, the tumor localization is the most pivotal landmark. RFID markers placed near the tumor would be the most reliable. In the current study, for anatomical resection, we used a combination of techniques with preoperative 3-dimensional image, intravenous indocyanine green injection, and RFID markings. Finally, you asked about the optimal operation style in small lung cancers. In 10 wedge resections, 3 lesions were diagnosed as adenocarcinoma. All 3 lesions were subcentimeter nodules. Because surgical margins were secured with more than 10 mm, we did not perform anatomical resection. Because all of the part-solid tumors were pathologically diagnosed as adenocarcinoma, surgical resection was reasonable, rather than observation. In the current study, to demonstrate the potential accuracy of the wireless localization technique, we selected the cases whose tumors were hardly palpable and difficult to be identified by dyeing methods, which we have usually used because operative marking methods have been developed to shorten the time taken from incidental identification to diagnosis to maximize the opportunity for curability. We will further advance this wireless marking technique using RFID technology. Thank you. Dr Kim. Thank you for your wonderful presentation and for your and your group's contributions to our field.