Virtual-assisted lung mapping (VAL-MAP) shortened surgical time of wedge resection

Abstract

Background: The detection of extremely small lung tumors has increased with the development of computed tomography. Resection of such tumors by thoracoscopy is often hindered due to the unclear location of the tumor. Various methods of preoperative determination of such lesions have been attempted, but without marked success. Here we used virtual-assisted lung mapping (VAL-MAP) to perform surgical resection of small lung lesions. Methods: We selected patients with pulmonary tumors that we anticipated to be difficult to identify during thoracoscopy and/or decide the resection line for sub-lobar lung resection. The wedge resections in the VAL-MAP group were compared to a group of patients who underwent wedge resection without VAL-MAP in 2013. Results: Surgery duration was significantly shorter in the VAL-MAP group (average: 76.4 min) than in the 2013 group (average: 108.6 min; P=0.000451), although the VAL-MAP group (average major axis: 9.6 mm) had smaller tumors (P=0.000032) and more pure ground-glass opacities (GGOs) (P=0.0000919) than the 2013 group (average major axis: 16.6 mm). Conclusions: The findings of this study indicate that VAL-MAP is efficacious. In particular, VAL-MAP resulted in a shorter surgery duration and has expanded the indications of resectable lesions.

Palpitation and virtual-assisted lung mapping: not mutually exclusive but complementary to facilitate sublobar lung resection

“…We have published a systematic review of bronchoscopic marking techniques, including VAL-MAP, in which we demonstrated that bronchoscopic marking procedures have never resulted in serious complications; however, there may have been some publication bias (8). Additionally, although it has been claimed that one advantage of the palpation method is a shorter surgical time (1), a previous study has reported that VAL-MAP shortens surgical time (9). Indeed, as many thoracic surgeons have experienced, localization by palpation is usually quick and easy; however, when it is not, the procedure can become extremely time consuming and even nightmarish.…”