The utility of electromagnetic navigational bronchoscopy as a localization tool for robotic resection of small pulmonary nodules

Background: Resection of small pulmonary nodules with minimally invasive techniques can be challenging when the lesions are not palpable. Localizing theses nodules by electromagnetic navigational bronchoscopy (ENB) techniques has not been well studied.

Methods: A review of our thoracic surgery database was performed for patients undergoing ENB localization of pulmonary nodules for robotic resection between August 2012 and April 2013.

Results: 19 patients were identified who underwent a combined localization with ENB and then da Vinci robotic lung resection. A transbronchial needle biopsy was performed in 14 patients followed by methylene blue dye marking on the pleural surface to localize the lesion. Five patients did not have a needle biopsy and underwent dye marking only. After dye marking, patients underwent robotic resection. Three patients who underwent transbronchial needle biopsy were found to have a diagnosis of malignancy and no diagnostic resection was needed. We proceeded directly to anatomic resection. Four patients had lesions too deep for a wedge resection, and a diagnostic segmentectomy was needed. The remaining 11 patients required a diagnostic wedge resection. The median time for the ENB portion of the procedure was 28 minutes. No adverse events were related to the placement of the dye marker, and no patients underwent conversion to an open procedure to localize the lesion.

Conclusions: We found ENB to be a safe and effective technique for localization of small pulmonary nodules with the diagnostic needle biopsy, possibly altogether negating the need for a wedge resection without adding significant time to the procedure.