Geometric localization technique combined with modified inflation-deflation method identifies both GGO location and intersegmental planes in pulmonary segmentectomy

PURPOSE: To evaluate the value of the combination of geometric localization technique (GLT) with modified inflation/deflation method (MIDM) in segmentectomy for pulmonary ground-glass opacity (GGO). METHODS: This prospective cohort study included 654 patients undergoing pulmonary segmentectomy between 2022-8-7 and 2023-6-27. The patients were divided into two groups: GLT + MIDM (n = 203) and MIDM (n = 436). GLT was performed to locate the GGO using three-dimensional parameters measured on preoperative images, and the intersegmental plane was visualized by using MIDM. The data were prospectively collected and statistically analyzed. Propensity score matching (PSM) was used to reduce the heterogeneity in baseline characteristics. RESULTS: The targeted segmental hilar structures were correctly identified, and the intersegmental plane was well visualized in both groups. After PSM (178 pairs), the GLT + MIDM group exhibited shorter operative time (84.2 ± 23.8 vs. 112.5 ± 37.8 min, P < 0.001), reduced blood loss (74.6 ± 43.2 vs. 103.6 ± 71.1 mL, P < 0.001), and shorter time to find the target GGO in the specimen (24.4 ± 17.9 vs. 122.8 ± 165.8 s, P < 0.001), compared to the MIDM group. Complication rates were comparable (8.4% vs. 16.9%, P = 0.727), with air leakage as the predominant complication. GLT achieved a 99.0% successful localization rate in marking the visceral pleura within 10 mm of the target GGO. CONCLUSIONS: The combination of GLT and MIDM method could simultaneously identify the location of GGO and the intersegmental plane. It might reduce operative time, blood loss, and the time to find the target GGO in the specimen, indicating that it might be helpful for segmentectomy.