Ten-Year Outcome and Development of Virtual-Assisted Lung Mapping in Thoracic Surgery

SIMPLE SUMMARY: Virtual-assisted lung mapping (VAL-MAP) is a preoperative bronchoscopic multispot dye-marking technique that has demonstrated efficacy and good outcomes over the last 10 years. However, conventional VAL-MAP has certain limitations. Several new techniques have been developed to address the problems associated with conventional VAL-MAP and have shown good results. Here, we summarize not only the history and outcomes of VAL-MAP, but also the latest update of this preoperative marking technique using bronchoscopy. ABSTRACT: Virtual-assisted lung mapping (VAL-MAP) is a preoperative bronchoscopic multispot dye-marking technique used in sublobar lung resection of barely palpable lung nodules. This review summarizes the history and outcomes of the VAL-MAP procedure. VAL-MAP was developed in 2012, and long-term outcomes of lung resection using VAL-MAP have recently been verified. Problems associated with conventional VAL-MAP include a prerequisite of post-mapping computed tomography (CT), occasional inability to see dye marks during surgery, and infrequent resection failure due to deep resection margins; various techniques have been developed to address these issues. VAL-MAP using electromagnetic navigation bronchoscopy with on-site adjustment can omit post-mapping CT. The use of indocyanine green in VAL-MAP has increased the success rate of marking detection during surgery without causing additional complications. VAL-MAP 2.0—a three-dimensional mapping technique that involves the intrabronchial placement of a microcoil—has increased the accuracy of sublobar resection, particularly for deeply located tumors. Although these promising new techniques have some limitations, they are beneficial for sublobar lung resection.