Advances in techniques for identifying small pulmonary nodules

  • Jun NakajimaEmail author
Review Article


Since the introduction of video-assisted thoracoscopic surgery, the demand for its use in resecting small pulmonary nodules has increased. In parallel, the development of high-resolution computed tomography has led to an increase in the detection of the early lung cancers appearing as nodules with ground-glass opacity. Several techniques to resect these small lesions have been devised, the most familiar of which is the use of a computed tomography-guided percutaneous hook wire. We recently developed virtual-assisted lung mapping to achieve safer and more reliable resection of these lesions. Virtual-assisted lung mapping is carried out using three-dimensional computed tomography, bronchoscopy, and fluoroscopically guided navigation to mark the lung surface with dye. A prospective study showed that this technique was safe and had a high success rate. Multiple marking around the targeted lesion allows for a sufficient surgical margin at resection. We recently introduced an electromagnetic navigation bronchoscopy system to confirm the sites to be marked by virtual-assisted lung mapping in the operating room prior to video-assisted thoracoscopic surgery. We are now studying a method to enable minimally invasive, safe, and reliable resection of lesions located deep in the lung parenchyma.


Pulmonary nodule Video-assisted thoracic surgery Virtual-assisted lung mapping 



I thank Dr. Masaaki Sato, who developed the VAL-MAP technique and provided me with useful suggestions in writing this article. To write this review article, I received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

Jun Nakajima has no conflicts of interest.


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© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Thoracic Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan

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