The role of virtual-assisted lung mapping 2.0 combining microcoils and dye marks in deep lung resection

Abstract Objectives Virtual-assisted lung mapping (VAL-MAP) 2.0 is a novel preoperative bronchoscopic lung mapping technique combining the multiple dye marks of conventional VAL-MAP with intrabronchial microcoils to navigate thoracoscopic deep lung resection. This study’s purpose was to evaluate the feasibility of VAL-MAP 2.0 in resecting deeply-located pulmonary nodules with adequate margins. Methods A multicenter, prospective single-arm study was performed from 2019 to 2020 in eight institutions. The selection criteria were barely identifiable nodules requiring sublobar lung resections, and nodules requiring resection lines reaching the inner 2/3 of the pulmonary lobe on CT images in wedge resection, or the nodule center located in the inner 2/3 of the pulmonary lobe in wedge resection or segmentectomy. Resection margins larger than either 2 cm or the nodule diameter were considered successful resection. Bronchoscopic placement of multiple dye marks and microcoil(s) was conducted 0–2 days before surgery. Results We analyzed 65 lesions in 64 patients. The diameter and depth of the targeted nodules and the minimum required resection depth reported as median (interquartile range) were 9 (7–13) mm, 11 (5–15) mm, and 30 (25–35) mm, respectively. Among 60 wedge resections and 5 segmentectomies, successful resection was achieved in 64/65 resections (98.5%; 95% confidence interval (CI), 91.7%–100%). Among 75 microcoils placed, 3 showed major displacement after bronchoscopic placement. There were no severe adverse events associated with the VAL-MAP procedure. Conclusions This study demonstrated that VAL-MAP 2.0 can facilitate successful resections for deep pulmonary nodules, overcoming the limitations of conventional VAL-MAP.