Real-time computed tomography fluoroscopy-guided dye marking prior to robotic pulmonary resection

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Medical Imaging

Background:

• Robotic surgery lacks tactile feedback, making tumor localization challenging.
• Visual cues are primary for surgeons, necessitating improved localization methods.
• Preoperative marking techniques are explored to enhance robotic pulmonary nodule resection.

Purpose of the Study:

• To evaluate the efficacy and safety of CT-guided dye marking for lung nodules before robotic surgery.
• To assess the feasibility of dye marking in improving intraoperative visualization and resection.
• To determine the complication rates associated with the dye marking procedure.

Main Methods:

• Retrospective analysis of patients undergoing CT-guided dye marking before robotic surgery (September 2019 - April 2024).
• Utilized indigo carmine and indocyanine green for dye marking of pulmonary nodules.
• Assessed visualization rates, complications, and subsequent surgical outcomes.

Main Results:

• Successful dye marking in 29/30 (96.7%) lung nodules across 29 patients.
• Indigo carmine and indocyanine green were used for 20 and 10 nodules, respectively.
• Slight pneumothorax occurred in 20.7% of patients, with no need for chest tubes. All nodules were resected with negative margins.

Conclusions:

• CT-guided dye marking is a feasible and safe adjunct for robotic pulmonary nodule resection.
• This method enhances the ability to perform robotic sublobar resections accurately.
• Improved nodule visualization facilitates precise surgical planning and execution in robotic thoracic procedures.