Localizing small lung lesions in video-assisted thoracoscopic surgery via radiofrequency identification marking



To facilitate accurate localization of small lung lesions in thoracoscopic surgery, we employed a micro-radiofrequency identification tag designed to be delivered through the 2-mm working channel of a flexible bronchoscope. This report presents the results of preclinical studies of our novel localizing technique in a canine model.


To evaluate functional placement, three types of tags [Group A, tag alone (n = 18); Group B, tag + resin anchor (n = 15); and Group C, tag + NiTi coil anchor (n = 15)] were bronchoscopically placed in subpleural areas and subsegmental bronchi via our new delivery device; tags were examined radiographically on days 0–7 and day 14. In addition, eight tags, which were placed at a mean depth of 13.3 mm (range 9–15.7 mm) from visceral pleura in bronchi with a mean diameter of 1.46 mm (range 0.9–2.3 mm), were recovered by partial lung resection under video-assisted thoracoscopic surgery using a 13.56-MHz wand-shaped probe with a 30-mm communication range.


Peripheral airway placement: Group C had a significantly higher retention rate than the other two groups (retention rate at day 14: Group A, 11.1 %; Group B, 26.7 %; Group C, 100.0 %; P < 0.0001). Central airway placement: Overall retention rate was 73.3 % in Group C, and placement was possible in bronchi of up to 3.3 mm in diameter. Outcomes of partial resection: Tag recovery rate was 100 %, mean time required for tag detection was 10.8 s (range 8–15 s), and mean surgical margin from the delivered tag was 9.13 mm (range 6–13 mm).


Radiofrequency identification marking enabled accurate localization with depth, which could ensure effective deep resection margins.

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We wish to thank Seiki Hasegawa (Hyogo College of Medicine, Hyogo, Japan), Tatsuo Nakagawa (Tenri Hospital, Nara, Japan), and Hiromichi Katakura (Otsu Red Cross Hospital, Shiga, Japan) for providing valuable suggestions regarding this project.


Hogy Medical Co., Ltd. provided the radiofrequency identification system and financial support by means of an institutional research grant.

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Correspondence to Toshihiko Sato.

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We guarantee that all authors are aware of and agree to the contents of the paper and their being listed as an author on this paper. All authors have contributed significantly to the content of the article. All authors have read and approved the submission of the manuscript to Surgical Endoscopy. Subject to acceptance, authors will sign an exclusive license to publish. Drs. J. Zhang, Y. Muranishi, Y. Sakaguchi, T. Komatsu, F. Kojima, and T. Nakamura have no conflicts of interest or financial ties to disclose. Y. Yutaka, T, Sato, and H. Date have a financial relationship with Hogy Medical Co., Ltd., which developed the radiofrequency identification system used in this study. The results were collected and analyzed independent from any sponsor.

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A marking tag placed at a depth of 13.3 mm in left S6 as indicated on computed tomography was recovered by video-assisted thoracoscopic surgery partial lung resection. The implanted tag was detected in the plastic grasper. The lung was resected by electrocautery with accurate adjustment of the resection line by detecting tag position. (MP4 42859 kb)

A marking tag placed at a depth of 13.3 mm in left S6 as indicated on computed tomography was recovered by video-assisted thoracoscopic surgery partial lung resection. The implanted tag was detected in the plastic grasper. The lung was resected by electrocautery with accurate adjustment of the resection line by detecting tag position. (MP4 42859 kb)

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Yutaka, Y., Sato, T., Zhang, J. et al. Localizing small lung lesions in video-assisted thoracoscopic surgery via radiofrequency identification marking. Surg Endosc 31, 3353–3362 (2017).

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  • Radiofrequency identification tag
  • Localization
  • Small lung lesion
  • Video-assisted thoracoscopic surgery
  • Wedge resection
  • Surgical navigation