Commentary: Finding a needle in a haystack—technology and innovation for precise intraoperative localization of deep-seated pulmonary nodules

Abstract

Video-assisted thoracoscopic surgery without adjunctive localization techniques is best used for mediumto largesized nodules located superficially or close to the pleural surface, because of the ability to visually inspect or palpate these lesions. For deeper nodules, accurate localization can be challenging, and various techniques have been used preoperatively, including the use of hook wires, fiducial markers, micro-coils, injected dyes, and fluoroscopy. The choice of technique depends on its availability, safety, operator experience, hospital resource availability, and costand time-effectiveness. We read with great interest and congratulate Sato and colleagues on their article on clinical application of a radiofrequency identification (RFID) marking system. The authors propose a novel technique to precisely locate small pulmonary nodules intraoperatively based on RFID technology. In their technique, a radiofrequency tag is inserted under virtual bronchoscopy and fluoroscopic guidance in proximity to the target lesion, the position of which is then confirmed with cone beam computed tomography. This tag communicates with an antenna to aid localization of the nodule intraoperatively and allow successful wedge resection with clear margins.