Efficiency of robotic-assisted thoracic surgery in resection of nodules previously localised with embolisation...

Advanced imaging and lung cancer screening programmes have led to increased detection of small pulmonary nodules, highlighting the need for localisation techniques. CT-guided microcoil localisation facilitates intraoperative identification of such nodules. Its use in conjunction with robot assisted thoracic surgery (RATS) remains under investigation. This study aims to evaluate the safety and efficiency of RATS for resection of lung nodules following microcoil localisation. A retrospective analysis of patients who underwent CT-guided microcoil localisation followed by RATS resection (January 2018 - May 2025) was performed. Demographic, procedural, and outcome data was collected, including localisation success, type of ultimate resection (including conversion to lobectomy), margin status, complications and others. Multivariable analysis identified independent risk factors for conversion to unplanned lobectomy. Sixty-four patients were included in the analysis, with a lesion mean size 12.5 ± 5.6 mm. Sublobar resection (wedge or anatomical) was achieved in 90.6% (n = 58) of patients. All patients achieved R0 resection. Unplanned completion lobectomy was necessary in 9.4% (n = 6) of cases and was associated with microcoil position within the lung parenchyma or fissure, compared to the visceral pleura (30.8% vs. 3.9%, p = 0.001), as well as shorter resection margins (after the initial wedge resection) (9.7 ± 7.2 vs. 15.2 ± 6.7 mm, p = 0.04). Microcoil dislodgement occurred in one patient. The most common complication was small pneumothorax (37.5%), with only one patient requiring chest drain insertion. CT-guided microcoil localisation is safe and effective for intra-operative localisation of lung nodules and allows for smaller resections and avoidance of completion lobectomy with low morbidity.