Conventional virtual-assisted lung mapping (VAL-MAP), also termed multi-spot preoperative bronchoscopic lung marking, necessitates post-mapping computed tomography (CT) to confirm the locations of dye markings. We hypothesized that electromagnetic navigation bronchoscopy (ENB) simplifies VAL-MAP by omitting post-mapping CT.
Under general anesthesia, real-time navigation bronchoscopy was conducted using ENB to reach a site as close to the planned location as possible, and indigo carmine was injected. Initially, surgery was then performed (no-adjustment group; 5 lesions of 3 patients). Later, on-site adjustment was added before surgery (adjustment group; 4 lesions of 4 patients), in which the locational information of ENB was transferred to a radiology workstation to construct an adjusted three-dimensional image. The accuracy of each predicted marking location was graded based on intraoperative observation. After the analysis, 19 patients with 21 lesions underwent ENB VAL-MAP with on-site adjustment (practice set) to evaluate the surgical outcomes.
The accuracy of the predicted marking location was significantly higher in the adjustment than no-adjustment group (4.7 ± 0.7 vs. 3.4 ± 1.2, respectively; P = 0.01), especially among the markings for which the bronchoscope did not reach the planned location (4.5 ± 0.8 vs. 2.6 ± 0.5, respectively; P = 0.004). In the practice set, the lung map quality was satisfactory and the resection outcome was successful with a sufficient macroscopic resection margin in 19/21 lesions (90.5%).
The ENB VAL-MAP quality was improved by adding on-site adjustment, achieving clinical outcomes similar to conventional VAL-MAP. The logistic challenge of post-mapping CT in conventional VAL-MAP can be partially overcome by ENB VAL-MAP with on-site adjustment.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Dendo S, Kanazawa S, Ando A, Hyodo T, Kouno Y, Yasui K, et al. Preoperative localization of small pulmonary lesions with a short hook wire and suture system: experience with 168 procedures. Radiology. 2002;225:511–8.
Kha LT, Hanneman K, Donahoe L, Chung T, Pierre AF, Yasufuku K, et al. Safety and efficacy of modified preoperative lung nodule microcoil localization without pleural marking: a pilot study. J Thorac Imaging. 2016;31:15–22.
Lachkar S, Baste JM, Thiberville L, Peillon C, Rinieri P, Piton N, et al. Pleural dye marking using radial endobronchial ultrasound and virtual bronchoscopy before sublobar pulmonary resection for small peripheral nodules. Respiration. 2018;95:354–61.
Sortini D, Feo C, Maravegias K, Carcoforo P, Pozza E, Liboni A, et al. Intrathoracoscopic localization techniques. Review of literature. Surg Endosc. 2006;20:1341–7.
Awais O, Reidy MR, Mehta K, Bianco V, Gooding WE, Schuchert MJ, et al. Electromagnetic navigation bronchoscopy-guided dye marking for thoracoscopic resection of pulmonary nodules. Ann Thorac Surg. 2016;102:223–9.
Seguin-Givelet A, Grigoroiu M, Brian E, Gossot D. Planning and marking for thoracoscopic anatomical segmentectomies. J Thorac Dis. 2018;10:S1187–94.
Sato M, Omasa M, Chen F, Sato T, Sonobe M, Bando T, et al. Use of virtual assisted lung mapping (VAL-MAP), a bronchoscopic multispot dye-marking technique using virtual images, for precise navigation of thoracoscopic sublobar lung resection. J Thorac Cardiovasc Surg. 2014;147:1813–9.
Sato M. Virtual assisted lung mapping: navigational thoracoscopic lung resection. Cancer Res Front. 2016;2:85–104.
Sato M, Kobayashi M, Kojima F, Tanaka F, Yanagiya M, Kosaka S, et al. Effect of virtual-assisted lung mapping (VAL-MAP) in acquisition of surgical margins in sublobar lung resection. J Thorac Cardiovasc Surg. 2018;156:1691–701.
Sato M, Kuwata T, Yamanashi K, Kitamura A, Misawa K, Imashimizu K, et al. Safety and reproducibility of virtual-assisted lung mapping: a multicentre study in Japan. Eur J Cardiothorac Surg. 2017;51:861–8.
Sato M, Nagayama K, Kuwano H, Nitadori JI, Anraku M, Nakajima J. Role of post-mapping computed tomography in virtual-assisted lung mapping. Asian Cardiovasc Thorac Ann. 2017;25:123–30.
Leong S, Ju H, Marshall H, Bowman R, Yang I, Ree AM, et al. Electromagnetic navigation bronchoscopy: a descriptive analysis. J Thorac Dis. 2012;4:173–85.
Sato M, Yamada T, Menju T, Aoyama A, Sato T, Chen F, et al. Virtual-assisted lung mapping: outcome of 100 consecutive cases in a single institute. Eur J Cardiothorac Surg. 2015;47:e131–9.
Kuwata T, Shinohara S, Matsumiya H, Takenaka M, Oka S, Chikaishi Y, et al. Virtual-assisted lung mapping (VAL-MAP) shortened surgical time of wedge resection. J Thorac Dis. 2018;10:1842–9.
Sato M, Nagayama K, Kobayashi M, Nakajima J. Virtual-assisted lung mapping 2.0: preoperative bronchoscopic three-dimensional lungmapping. Ann Thorac Surg. 2019. https://doi.org/10.1016/j.athoracsur.2019.01.058.
We thank Angela Morben, DVM, ELS, from Edanz Group (www.edanzediting.com/ac), for editing a draft of this manuscript.
The study was funded by the Japan Agency for Medical Research and Development.
Conflict of interest
There is no conflict of interest to declare.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Sato, M., Shinohara, Y., Yanagiya, M. et al. Use of electromagnetic navigation bronchoscopy in virtual-assisted lung mapping: the effect of on-site adjustment. Gen Thorac Cardiovasc Surg 67, 1062–1069 (2019). https://doi.org/10.1007/s11748-019-01137-z