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Cancer Research Frontiers. 2016 Feb; 2(1): 85-104. doi: 10.17980/2016.85

Virtual assisted lung mapping: navigational thoracoscopic lung resection

Masaaki Sato.

Department of Thoracic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan

 

*Corresponding author: Masaaki Sato, MD, PhD. Tel: +81-3-5800-9155, Fax: +81-3-5800-9156, E-mail: satom-sur@h.u-tokyo.ac.jp

Citation: Masaaki Sato. Virtual assisted lung mapping: navigational thoracoscopic lung resection. Cancer Research Frontiers. 2016 Feb; 2(1): 85-104. doi: 10.17980/2016.85

Copyright: @ 2016 Masaaki Sato. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Competing Interests: The author declares no competing financial interests.

Received Nov 25, 2015; Revised Jan 28, 2016; Accepted Feb 11, 2016. Published Feb 26, 2016

 

Abstract

Virtual assisted lung mapping (VAL-MAP) is a new technique for bronchoscopic lung marking developed to assist in navigational lung resection. Unlike conventional marking techniques using a single marking to identify an intrapulmonary tumor, VAL-MAP utilizes multiple dye-mediated markings, providing “geometric information” on the lung surface. The purpose of the technique is to identify a tumor and obtain sufficient resection margins, either in wedge resection or segmentectomies. Computer-based virtual bronchoscopy is used to design the lung map and to identify target bronchi for each marking. The dye injection procedure is conducted using a regular bronchoscope under fluoroscopy followed by a CT scan, which is then reconstructed into 3D images for intraoperative navigation. The advantages of VAL-MAP include: it is a reasonably safe procedure based on experience from approximately 1,300 markings undertaken in >430 patients; the dye lasts without significant fading for 2–3 days; the technique has good reproducibility; and multiple markings and adjustment using post-mapping CT result in the procedure being highly resistant to technical failure. VAL-MAP is likely to benefit many patients and surgeons in the era of minimally invasive navigational-based thoracic surgery. The technique has scope for further development, making it an exciting new field of research in thoracic surgery.

Keywords: lung cancer, metastatic lung tumor, VATS, navigation, workstation, virtual bronchoscopy, lung marking, ground glass nodule

 

 

 

 

 

 

 

 

 

 

 

 

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