Effect of virtual-assisted lung mapping in acquisition of surgical margins in sublobar lung resection

Abstract

This study showed that virtual-assisted lung mapping has reasonable efficacy, although the successful resection rate did not reach the primary goal. The depth of the required margin was the most significant factor leading to resection failure.

Protocol for the VAL-MAP 2.0 trial: a multicentre, single-arm, phase III trial to evaluate the effectiveness of virtual-assisted lung mapping by bronchoscopic dye injection and microcoil implementation in patients with small pulmonary nodules in Japan

“…Thus, we assumed that a success rate of 60% is a valid threshold to conclude that VAL-MAP using microcoils combined with a multispot dye-marking technique is effective in obtaining sufficient surgical margins in sublobar lung resection. While the success rate of the preceding study of VAL-MAP was 87.7%,17 after restricting the subjects to those meeting the inclusion criteria of the presently proposed study, the success rate was 78%. The success rate of VAL-MAP 2.0 is expected to be far better than that of surgery without any marking (52%) and slightly better than that with VAL-MAP 1.0 (78%) in this trial population.…”

“…This lung map provides intraoperative assistance for the localisation of barely palpable lung nodules and can help surgeons to determine optimal resection lines for sublobar resection 10. A multicentre, clinical trial in Japan showed that VAL-MAP has a high degree of accuracy in mapping, achieves a successful resection rate of 87.7% (defined as tumour resection with adequate surgical margins) and has a satisfactory safety profile with only one serious case of subcutaneous emphysema 16 17. However, this previous study also revealed that the acquisition of resection margins for deeply located lung nodules is a limitation of VAL-MAP; multivariate analysis revealed that the most significant risk factor for resection failure was the presence of tumours with a required resection line depth of more than 30 mm from the pleural surface 17.…”

“…A multicentre, clinical trial in Japan showed that VAL-MAP has a high degree of accuracy in mapping, achieves a successful resection rate of 87.7% (defined as tumour resection with adequate surgical margins) and has a satisfactory safety profile with only one serious case of subcutaneous emphysema 16 17. However, this previous study also revealed that the acquisition of resection margins for deeply located lung nodules is a limitation of VAL-MAP; multivariate analysis revealed that the most significant risk factor for resection failure was the presence of tumours with a required resection line depth of more than 30 mm from the pleural surface 17. These findings indicate that it is critical to obtain accurate information on tumour depth and deep resection lines to ensure the success of sublobar lung resection.…”

Hybrid technique of virtual-assisted lung mapping and systemic indocyanine green injection for extended segmentectomy

“…Numerous techniques and approaches have been devised to assist segmentectomy [ 6 ]. Selective resected segmental inflation, systemic dye injection, endobronchial dye injection, and virtual-assisted lung mapping (VAL-MAP) are among those commonly used [ 7 – 12 ].…”

“…VAL-MAP is a safe, efficacious, bronchoscopic, multiple pulmonary dye-marking technique that uses virtual bronchoscopic navigation [ 7 , 13 ]. It can be used to create multiple marks near the tumor that allow accurate identification of the tumor during subsequent surgery [ 14 – 16 ].…”