CT-Guided Dual-Fluorescent Marking to Localize Small Pulmonary Nodules for Robotic Sublobar Resection: Technical Note...

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Medical Imaging

Background:

• Accurate localization of non-palpable pulmonary nodules is crucial for successful minimally invasive thoracic surgery.
• Conventional localization methods can be time-consuming and may involve radiation exposure.

Purpose of the Study:

• To describe and evaluate a CT-guided dual-fluorescent marking technique for intraoperative localization of pulmonary nodules during robotic-assisted thoracic surgery (RATS).
• To assess the feasibility and outcomes of this novel marking strategy.

Main Methods:

• Retrospective analysis of 84 patients undergoing RATS for pulmonary nodules (≤2 cm).
• CT-guided percutaneous injection of a dual-fluorescent agent (methylene blue + indocyanine green in fibrin-thrombin matrix) prior to surgery.
• Intraoperative visualization using near-infrared Firefly® imaging.

Main Results:

• All 84 nodules were successfully localized and resected with negative margins.
• No conversions to open surgery or complications related to the marking technique were reported.
• Mean operative time was 163.7 minutes; mean interval from marking to surgery was 74.6 minutes.
• No local recurrences observed during a mean follow-up of 17.3 months.

Conclusions:

• CT-guided dual-fluorescent marking is a practical, fluoroscopy-free method for localizing pulmonary nodules in RATS.
• The technique facilitates reliable sublobar resections with negative margins.
• Further prospective studies are needed to evaluate the specific contribution of methylene blue and compare with conventional techniques.