Image-Guided Uniportal VATS in the Hybrid Operating Room

  • Ze-Rui Zhao
  • Calvin S. H. NgEmail author


The development of imaging technology has recently facilitated uniportal minimally-invasive thoracic surgery techniques. Cone-beam computed tomography (CBCT) shows promising results in visualizing the target lesion and its surrounding critical anatomy, with an average error of less than 2 mm. The hybrid operation room (OR), which integrates CBCT and the OR, is capable of providing unparalleled real-time imaging of the patient, which can be incorporated into electromagnetic navigation bronchoscopic marking of pulmonary lesion to reduce the likelihood of navigation tool malpositioning and, hence increase procedural accuracy. Furthermore, implantation of hookwires or microcoils that are widely used to localize pulmonary lesions can proceed in the hybrid suite, eliminating the common complications and discomfort associated with the conventional workflow carried out in the radiology suite. Implantation displacement leading to localization failure can also be reduced, and sublobar resection can be performed without resecting a larger area of parenchyma than desired. This hybrid OR provides a one-stop concept for simultaneously diagnosing and managing tiny pulmonary lesions.


Image-guided Hybrid theater Localization 

Supplementary material

Video 1

Real-time fluoroscopy in hybrid operating room of methylene blue iodine contrast mixture dye marking injection adjacent to target lesion (lung lesion not well seen on fluoroscopy) showing a classical contrast blush near the end of video (MP4 39665 kb)

Video 2

Uniportal VATS wedge resection of a right upper lobe lesion precisely dye marked with methylene blue by image-guided electromagnetic navigation bronchoscopy in the hybrid operating room (MP4 347368 kb)


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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales HospitalThe Chinese University of Hong KongHong Kong SARChina

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