Virtual bronchoscopic navigation based on lateral supine computed tomography yields better reproducibility of the peripheral branches than normal supine computed tomography

<bold>Background & Objectives:</bold> Peripheral bronchi may be difficult to observe on chest computed tomography (CT) because of the effect of gravity. In virtual assisted lung mapping (VAL-MAP), lateral CT is always taken after bronchoscopic marking with indigo carmine 1）. In this study, we compared the reproducibility of the peripheral branches between virtual bronchoscopic navigation (VBN) based on post-marking lateral supine CT and preoperative normal supine CT. <bold>Methods:</bold> This study included cases in which VAL-MAP was performed at our respiratory surgery center from April 2014 to October 2023. VBN was performed using VINCENT software based on preoperative normal supine CT and post-marking lateral supine CT. One observer read the lobar bronchus as the primary branch and counted how many branches were reproduced up to the lesion. Differences between groups were analyzed by t-test. <bold>Results:</bold> There were 360 cases, including 155 and 105 males and females, respectively (age: 27–67 years, median age: 67 years). VBN based on preoperative normal supine CT and post-marking lateral supine CT reproduced an average of 5.29 and 5.44 branches, respectively (P < 0.05). For lesions in the right segment—particularly (S)3, S6, S8, left S1+2, and S9 lesions—post-marking lateral supine CT showed superior reproduction of the lesions to the peripheral branches. <bold>Conclusions:</bold> VBN based on post-marking lateral supine CT yields better reproducibility of the peripheral branches, especially in areas that are higher in the lateral supine position. 1)Sato M, Omasa M, Chen F, et al. J Thorac Cardiovasc Surg. 2014 Jun;147(6):1813-9.