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Related Experiment Video

Updated: Oct 23, 2025

Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery
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Electromagnetic navigation-guided preoperative localization: the learning curve analysis.

Jiang Shi1,2, Jiaxi He1,2, Jianxing He1,2

  • 1Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

Journal of Thoracic Disease
|August 23, 2021
PubMed
Summary

Electromagnetic navigation bronchoscopy (ENB) for pulmonary nodule localization shows a learning curve. Technical competency for ENB-guided preoperative localization is achieved around the 47th procedure, indicated by improved success rates and accuracy.

Keywords:
Electromagnetic navigation bronchoscopy (ENB)learning curvepulmonary nodule localization

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Area of Science:

  • Pulmonology
  • Interventional Pulmonology
  • Surgical Navigation

Background:

  • Electromagnetic navigation bronchoscopy (ENB) is increasingly used for marking pulmonary nodules (PNs) for video-assisted thoracic surgery (VATS).
  • High effectiveness and low risk make ENB a preferred method for PN localization.
  • No prior studies have detailed the learning curve for ENB-guided preoperative PN localization.

Purpose of the Study:

  • To describe the learning curve associated with ENB-guided preoperative pulmonary nodule localization.
  • To identify the number of procedures required to achieve technical competency in ENB localization.

Main Methods:

  • A consecutive series of 89 ENB localization procedures for PNs by a single surgeon were analyzed.
  • The cumulative sum (CUSUM) method was employed to assess the learning curve.
  • Procedures were categorized into three phases based on experience.

Main Results:

  • The learning curve comprised three phases: Phase I (1-11 cases), Phase II (12-47 cases), and Phase III (48-89 cases).
  • Success rates significantly increased across phases: 72.73% (Phase I), 91.67% (Phase II), and 97.62% (Phase III) (P=0.049).
  • Localization accuracy improved, with shorter distances from the guide wire tip to the lesion center in later phases. Operative time was influenced by learning curve phase, sex, and bronchus sign.

Conclusions:

  • Technical competency in ENB-guided preoperative PN localization, marked by higher success rates, improved accuracy, and shorter operative times, was achieved by the 47th procedure.
  • The study provides a benchmark for surgeon training and quality assessment in ENB procedures.
  • ENB is a valuable tool for preoperative localization of PNs, with a defined learning curve for optimal outcomes.