The benefits of electromagnetic navigation bronchoscopy combined with fluorescence-guided thoracoscopy in precise pulmonary segmentectomy: a propensity score-matched analysis.

BACKGROUND

Precise pulmonary segmentectomy faces two major challenges: accurate nodule localization and clear intersegmental plane visualization. To address these, we developed a new comprehensive surgical protocol integrating Electromagnetic Navigation Bronchoscopy (ENB) with fluorescence-guided thoracoscopy and compared it with traditional surgical approaches to evaluate its feasibility and benefits.

METHODS

This retrospective study analyzed patients undergoing pulmonary segmentectomy at Northern Jiangsu People's Hospital (January 2020-January 2024). Patients were divided into dual-scope and traditional groups. Propensity Score Matching (PSM) was performed for gender, age, body mass index (BMI), the American Society of Anesthesiologists (ASA), Forced Expiratory Volume in 1 second (FEV%), smoking, chronic obstructive pulmonary disease (COPD), hypertension, diabetes, and coronary artery disease (CAD). Intraoperative and postoperative outcomes were compared.

RESULTS

After PSM, a total of 242 patients (121 per group) were included. Localization time (16.1 ± 7.2 vs. 21.0 ± 9.9 min) and segmentectomy time (75.8 ± 35.5 vs. 90.7 ± 46.3 min) were significantly shorter in the dual-scope group. Localization-related complications included focal pulmonary hemorrhage (0% in the dual-scope group vs. 5.0% in the traditional group), pneumothorax (0.8% vs. 5.0%), localization failure (0.8% vs. 6.6%), and intersegmental plane visualization failure (0% vs. 1.7%). All differences were significant (p < 0.05).

CONCLUSION

ENB combined with fluorescence-guided thoracoscopy addresses challenges in precise localization and intersegmental plane visualization, significantly improving the safety, accuracy, and feasibility of pulmonary segmentectomy.