Real-time margin assessment for video-assisted thoracic surgery: A pilot clinical trial

Area of Science:

• Thoracic Surgery
• Surgical Navigation
• Medical Devices

Background:

• Lung cancer screening detects smaller nodules, necessitating sublobar resection for lung function preservation.
• Accurate margin assessment during lung nodule resection is challenging due to lung deformation.
• Sublobar resection offers comparable outcomes to lobar resection for early-stage lung cancer.

Purpose of the Study:

• To evaluate a novel navigation system for real-time intraoperative margin guidance during lung cancer resection.
• To establish the safety and feasibility of a new system using a tumor marker (J-bar) and sensor-equipped stapler.
• To compare intraoperative software measurements with postoperative pathological findings for resection margins.

Main Methods:

• A novel navigation system was developed, including a J-bar tumor marker, a sensor-instrumented surgical stapler, and real-time distance computation software.
• The system's intraoperative J-bar-to-stapler cutline distance (J-bar-tip) was measured in real time and compared to pathology results.
• Twenty-two lung cancer resection procedures were analyzed, assessing nodule size, pleural distance, and device placement times.

Main Results:

• Complete nodule resection was achieved in all 22 procedures.
• The median time for J-bar placement was 2.8 minutes and stapler clamping was 1.8 minutes.
• A significant correlation was found between intraoperative software readings and pathological J-bar-tip measurements; no adverse events occurred.

Conclusions:

• The novel navigation system is safe and feasible for intraoperative guidance during lung cancer surgery.
• The system accurately provides real-time distance measurements from the tumor marker to the stapler cutline.
• This technology aids in achieving sufficient resection margins, crucial for lung-sparing procedures.