Intraoperative localization of small pulmonary nodules to assist surgical resection: A novel approach using a surgical navigation puncture robot system

Background Localization and resection of nonvisible, nonpalpable pulmonary nodules during video-assisted thoracoscopic surgery is challenging. In this study we developed a surgical navigation puncture robot system in order to locate small pulmonary nodules before thoracoscopic surgery. Methods Four pigs were divided into group A and group B and underwent positioning puncture with the aid of the robotic system. The pigs in group A breathed freely during the experiment, whilst mechanical ventilation was used on the pigs in group B. Results Using the robotic system to locate nodules achieved good results. For group A, a total of nine simulated nodules were created and successfully localized. The mean positioning accuracy was 9.6 ± 4.9 mm (range, 3.2-17.4 mm), and the time required for system positioning was 7.1 ± 1.0 minutes (range, 5.6-8.2 minutes). For group B, a total of 23 simulated nodules were created and successfully localized. The mean positioning accuracy was 2.9 ± 1.5 mm (range, 0.7-5.9 mm), and the time required for system positioning was 7.8 ± 1.1 minutes (range, 6.3-9.7 minutes). Conclusions The new method using a surgical navigation puncture robot system to locate small pulmonary nodules is feasible and safe, and its positioning accuracy is sufficient to meet clinical requirements. In addition, results indicated that breathing had a great influence on the positioning accuracy, mainly in the longitudinal direction. Our surgical navigation puncture robot system has wide future applications for accurately locating small pulmonary nodules in a clinical setting. Key points Significant findings of the study: A new method using a surgical navigation puncture robot system was developed to locate small pulmonary nodules before thoracoscopic surgery. The results indicated that this method can provide accurate localization and permit smaller and more precise resections. What this study adds A surgical navigation puncture robot system has wide future applications for accurately locating small pulmonary nodules in a clinical setting.