Vectorial localization of peripheral pulmonary lesion guided by electromagnetic navigation: A novel method for diagnostic surgical resection without dye marking

Abstract

We describe a novel method using electromagnetic navigation bronchoscopy (ENB) without dye marking to perform vectorial localization for an impalpable peripheral lesion in the right lower lobe during diagnostic surgical resection in a 52‐year‐old woman. After the ENB registration process, the anesthetist changed the single‐lumen endotracheal tube to a double‐lumen endobronchial tube. Guided by the ENB system, the operator delivered the probe of the locatable guide to the planned site through the right lumen of the endobronchial tube. The ENB system allows calculation of the direction and distance between the probe and the lesion, confirming the relative location of the lesion. The locatable guide was retained during surgery as an intraoperative indicator, rather than applying dye marking. During video‐assisted thoracoscopic surgery, the protuberant visceral pleura poked by the probe accurately indicated the relative location of the lesion. Accordingly, we performed precise wedge resection for diagnosis, followed by lobectomy, resulting in a diagnosis of invasive adenocarcinoma. Vectorial localization is an alternative method of ENB‐guided localization to peripheral pulmonary lesions, which can provide the accurate location of such lesions for diagnostic surgical resection.

Identification of the intersegmental plane via electromagnetic navigation for anatomical segmentectomy

“…The ENB procedure is comprised of three fundamental techniques: three‐dimensional reconstruction, virtual localization, and electromagnetic navigation. We previously described the vectorial localization of peripheral pulmonary lesions using electromagnetic navigation, demonstrating that the LG/EWC could precisely reach the sub‐pleura 11 . Owing to its demonstrated accuracy and efficiency, ENB with methylene blue dye‐marking has emerged as a viable alternative for preoperative pulmonary nodule localization 12 .…”

“…We previously described the vectorial localization of peripheral pulmonary lesions using electromagnetic navigation, demonstrating that the LG/EWC could precisely reach the sub‐pleura. 11 Owing to its demonstrated accuracy and efficiency, ENB with methylene blue dye‐marking has emerged as a viable alternative for preoperative pulmonary nodule localization. 12 Furthermore, the methylene blue solution could diffuse into pulmonary lobules, forming a polygonal blue area with sharp margins in the sub‐pleura.…”