Combined virtual-assisted lung mapping (VAL-MAP) with CT-guided localization in thoracoscopic pulmonary segmentectomy

Shun-Mao Yang; Ching-Kai Lin; Li-Wei Chen; Yi-Chang Chen; Hsin-Chieh Huang; Huan-Jang Ko; Chung-Ming Chen; Masaaki Sato

doi:10.1016/j.asjsur.2018.06.005

Combined virtual-assisted lung mapping (VAL-MAP) with CT-guided localization in thoracoscopic pulmonary segmentectomy

Asian J Surg. 2019 Mar;42(3):488-494. doi: 10.1016/j.asjsur.2018.06.005. Epub 2018 Jul 20.

Authors

Shun-Mao Yang¹, Ching-Kai Lin², Li-Wei Chen³, Yi-Chang Chen⁴, Hsin-Chieh Huang⁵, Huan-Jang Ko⁶, Chung-Ming Chen³, Masaaki Sato⁷

Affiliations

¹ 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.
² Department of Internal Medicine, National Taiwan University Hospital, Taiwan.
³ Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taiwan.
⁴ Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taiwan; Department of Medical Imaging, National Taiwan University Hospital, Taiwan.
⁵ Department of Medical Imaging, National Taiwan University Hospital, Taiwan.
⁶ Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan. Electronic address: kaba@ms1.hinet.net.
⁷ Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan.

PMID: 30037641
DOI: 10.1016/j.asjsur.2018.06.005

Abstract

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.

Material and methods: 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.

Results: 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.

Conclusion: The combination of VAL-MAP and CT-guided percutaneous localization contribute to precise thoracoscopic pulmonary segmentectomy.

Keywords: CT-Guided localization; Lung cancer; Segmentectomy; VAL-MAP.

MeSH terms

Adult
Aged
Bronchoscopy / methods
Female
Humans
Lung / diagnostic imaging*
Lung Neoplasms / diagnostic imaging
Lung Neoplasms / surgery
Male
Middle Aged
Pneumonectomy / methods*
Surgery, Computer-Assisted / methods*
Thoracoscopy / methods*
Tomography, X-Ray Computed / methods*
Virtual Reality*