Utility and Safety of a Novel Preoperative Marking via Ultrathin Bronchoscopy in Thoracic Surgery.

PURPOSE: Virtual-assisted lung mapping (VAL-MAP) is a safe and useful procedure for identifying suitable lines for sublobar lung resections. Nonetheless, the current VAL-MAP technique using a thin bronchoscope limits access to peripheral lung regions, including the upper lobes or the S6 region.

METHODS

To overcome this limitation, we developed a new technique utilizing an ultrathin bronchoscope (UTB), termed 'UTB VAL-MAP', enabling precise dye marking of the visceral pleura which is difficult to access with a thin bronchoscope. We retrospectively evaluated the efficacy and safety of UTB VAL-MAP with those of conventional VAL-MAP at our institution.

RESULTS

Overall, 178 preoperative markings (75 patients) were included: 74 markings in 35 patients in the UTB VAL-MAP group and 104 markings in 40 patients in the conventional VAL-MAP group. The overall detection rate in the UTB VAL-MAP group was significantly higher than that in the conventional VAL-MAP group [97.3% (72/74) vs. 84.6% (88/104); P = 0.005]. Furthermore, the marking success rate using indigo carmine in the UTB VAL-MAP group was higher for lesions located in the upper lobe and S6 region than that in the conventional VAL-MAP group (P < 0.001). In multivariate generalized estimating equations models, UTB use (odds ratio = 7.390, P = 0.015) was significantly associated with overall detection rate. No severe procedure-related complications occurred in either group.

CONCLUSION

UTB VAL-MAP appears useful for increasing the rate of successful visceral pleura marking, particularly in the upper lobes or S6 areas, which the conventional VAL-MAP technique has difficulty reaching, without increasing complications.