ArticleJournal of thoracic disease2026
Initial experience with the EndoFusion 3D system for noninvasive intraoperative localization of pulmonary nodules.
Article in Journal of thoracic disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Intraoperative localization of small peripheral pulmonary nodules remains difficult during video-assisted thoracoscopic surgery (VATS), especially for subcentimeter and ground-glass-predominant lesions. Conventional computed tomography (CT) guided localization is effective but invasive and carries radiation exposure and puncture-related risks. This study assessed the feasibility and safety of EndoFusion, a system that projects preoperative three-dimensional (3D) information onto real-time thoracoscopic views to assist localization. Methods: A single-center retrospective study was conducted on patients undergoing VATS sublobar resection with EndoFusion-assisted localization. Preoperative 3D models were generated from thin-slice CT and registered to the pleural surface intraoperatively. Technical success, localization accuracy, perioperative outcomes, and complications were assessed. Results: Fifteen patients with a total of 19 peripheral pulmonary nodules were included. The median nodule size was 8.0 mm and the median pleural depth was 3.0 mm, with most lesions characterized as pure ground-glass nodules (pGGNs) or consolidation-to-tumor ratio (CTR) ≤0.25. All patients successfully underwent VATS resection without conversion, including wedge resection (60.0%), combined wedge and segmentectomy (26.7%), or segmentectomy (13.3%). The median operative time was 75 minutes, and EndoFusion registration was completed in a median of 128 seconds. Intraoperative blood loss was minimal (median 50 mL), and no intraoperative complications occurred. Two patients (13.3%) developed minor postoperative complications, and the median hospital stay was 4 days. Conclusions: EndoFusion provides a feasible, safe, and fully noninvasive intraoperative localization method for VATS. By projecting patient-specific 3D anatomy directly onto the operative field, it enhances precision, reduces cognitive burden, and may serve as an effective alternative to conventional preoperative localization.
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