Intraoperative margin assessment by wireless signals in thoracoscopic anterior (S3) segmentectomy using a radiofrequency identification marker

Abstract

Despite the use of near-infrared thoracoscopy with intravenous indocyanine green, intraoperative assessment of the surgical margin for the resection of non-palpable tumors located near the intersegmental plane requires highly advanced surgical skill for the prevention of local recurrence. Because the demarcation line is limited to the pleural surface, to overcome uncertainty in tumor palpation for deeply located small-sized lesions, other supplemental localization techniques have been proposed. Here, we present a novel surgical technique using radiofrequency identification markers for intraoperative assessment of the lateral surgical margin in segmentectomy.

A simple and safe surgical technique for nonpalpable lung tumors: One-stop Solution for a nonpalpable lung tumor, Marking, Resection, and Confirmation of the surgical margin in a Hybrid operating room (OS-MRCH)

“…Percutaneous CT-guided marking using microcoil or lipiodol is a safer method, with a lower incidence of complications, such as pneumothorax and air embolism than using hook wire ( 7 ). To ensure safe and accurate localization, several methods have been developed using a bronchoscopic approach to place dyes or markers near the tumor through the airways, such as virtual assisted lung mapping (VAL-MAP) ( 8 - 11 ) or radiofrequency identification (RFID) marking system ( 12 - 15 ). These methods ensure the precise identification of nonpalpable lung tumors and safe margins for resection, and their feasibility and applicability in lung segmentectomy have been reported.…”

“…VAL-MAP 2.0 identifies appropriate deep lung resection margins by implanting microcoil ( 16 ). In the RFID method, the tag is implanted at the same position as the tumor, allowing the margin to be estimated by scanning the resected lung ( 15 ). However, there are few reports on using of CT scans to confirm the resection margins of GGO lung tumors.…”

Is a single port enough for the learned thoracic surgeons?

“…In recent years, a novel wireless localization method called radiofrequency identification marking has been developed (12,13). These markers can be accurately localized via wireless communication and demonstrate the positional information with depth from the pleural surface to realize precise sublobar resection (14)(15)(16)(17). To facilitate tumor localization in the limited single-site platform, this technological advancement comprising a preoperative marking technique and an intraoperative navigation system may contribute to the development of less invasive uniportal segmentectomy.…”