Optical Navigation Robot-Assisted versus Conventional CT-Guided Localization of Pulmonary Nodules: A Comparison of Efficacy and Analysis of Complication Predictors.

PURPOSE: To compare the efficacy and safety of optical navigation robot-assisted versus conventional CT-guided preoperative localization of pulmonary nodules and to identify predictors of procedure-related pneumothorax and pulmonary hemorrhage.

MATERIALS AND

METHODS

In this retrospective study, 108 patients scheduled for video-assisted thoracoscopic surgery underwent preoperative CT-guided hook-wire localization, either with optical navigation robot assistance (navigation group, n = 53) or conventionally (conventional group, n = 55). Procedural metrics (first-attempt success rate, wire-to-nodule distance, number of CT scans, radiation dose) and complications were compared. Multivariable logistic regression was performed to identify independent factors associated with pneumothorax and pulmonary hemorrhage.

RESULTS

The navigation group demonstrated a higher first-attempt success rate (94.34% vs. 80%; P = .03) and a shorter wire-to-nodule distance (4.09 mm vs. 6.40 mm; P = .03) with fewer CT scans required (3.05 vs. 3.20; P = .03), despite a higher radiation dose (172.37 vs. 124.64 mGy·cm; P < .01). Pneumothorax (39.62% vs. 52.73%; P = .17) and pulmonary hemorrhage (24.53% vs. 21.82%; P = .73) rates did not differ significantly. Multivariable analysis identified greater needle depth in the lung (OR: 0.87), greater chest wall thickness traversed (OR: 0.94) and first-attempt success (OR: 0.13) as protective factors against pneumothorax, while needle proximity to a rib (OR: 9.96) was a risk factor. Traversal of pulmonary vessels was the sole risk factor for pulmonary hemorrhage (OR: 11.93).

CONCLUSIONS

Optical navigation robot-assisted localization improves the precision of preoperative pulmonary nodule marking. The identified predictors of complications-needle proximity to a rib and traversal of pulmonary vessels-constitute actionable targets for procedural optimization.

LEVEL OF EVIDENCE: Level 3, Non-controlled retrospective cohort study.