Robotic-assisted navigation system for preoperative lung nodule localization: a pilot study

Background: Preoperative percutaneous computed tomography (CT)-guided localization of pulmonary nodules plays a pivotal role in the diagnosis and treatment of early-stage lung cancer. However, conventional manual localization techniques have inherent limitations in achieving a high degree of accuracy. Consequently, a novel robotic-assisted navigation system was developed to attain precise localization of small lung nodules. This study aims to investigate the accuracy and safety of this system in clinical applications. Methods: Patients with peripheral solitary pulmonary nodules measuring less than 20 mm were enrolled. The robotic-assisted navigation system generated a three-dimensional (3D) model based on the patient’s CT images, determining the optimal puncture path. The robotic arm then accurately located the nodule and, following percutaneous puncture, indocyanine green (ICG) was injected. The primary outcome measure was the accuracy of pulmonary nodule localization, while secondary outcomes included the complication rate, procedural duration, and total radiation exposure. Results: A total of 33 nodules were successfully localized using the robotic-assisted navigation system and resected through video-assisted thoracoscopic surgery (VATS). The first-pass success rate was 100%, with a median deviation of 6.1 mm [interquartile range (IQR), 2.5–7.2 mm] between the localizer and the nodule. The median localization time was 25.0 minutes, and the single and cumulative exam dose-length products (DLP) were 534.0 and 1491.0 mGy·cm, respectively. Notably, no observable complications were reported during the procedures. Conclusions: The innovative robotic-assisted navigation system demonstrated satisfactory accuracy and holds promise for improving the percutaneous localization of lung nodules. This method represents a safe and viable alternative to traditional CT-guided manual localization techniques.