Ten-Year Outcome and Development of Virtual-Assisted Lung Mapping in Thoracic Surgery.

Area of Science:

• Thoracic Surgery
• Pulmonology
• Medical Imaging

Background:

• Virtual-assisted lung mapping (VAL-MAP) is a bronchoscopic technique for marking lung nodules before surgery.
• Sublobar resection is challenging for barely palpable lung nodules.

Purpose of the Study:

• To review the history and outcomes of the VAL-MAP procedure.
• To summarize advancements addressing limitations of conventional VAL-MAP.

Main Methods:

• Review of historical data and outcomes of VAL-MAP.
• Analysis of modified VAL-MAP techniques including electromagnetic navigation bronchoscopy and indocyanine green.
• Evaluation of VAL-MAP 2.0 with intrabronchial microcoil placement.

Main Results:

• Conventional VAL-MAP has limitations: need for post-mapping CT, occasional poor dye visibility, and deep margin failures.
• Electromagnetic navigation bronchoscopy-assisted VAL-MAP can eliminate post-mapping CT.
• Indocyanine green enhances intraoperative dye-mark detection without complications.
• VAL-MAP 2.0 improves accuracy for deep-seated tumors.

Conclusions:

• VAL-MAP techniques have evolved significantly since 2012.
• Modified VAL-MAP approaches enhance safety and efficacy in sublobar lung resections.
• Despite limitations, advanced VAL-MAP techniques are beneficial for minimally invasive lung cancer surgery.