Evolving generations of computed tomography-guided lung nodule localisation toward stabilised fluorescent precision in robotic thoracic oncology

Abstract The short communication by Hamm and colleagues on CT-guided percutaneous lung nodule marking with patent blue V, indocyanine green, and indocyanine green–soaked coils underscores the growing integration of interventional radiology with robotic thoracic surgery as detection of small and subsolid lesions increases. While the reported technique offers an accessible, workflow-flexible roadmap—avoiding rigid transpleural devices until resection and minimizing reliance on intraoperative fluoroscopy—the field is moving beyond feasibility toward precision. We argue that diffusion control is central to spatial fidelity: visibility without accurate localisation may compromise margin geometry in sublobar resections. Emerging “stabilised” fluorescent matrices represent a conceptual next step by modulating dye distribution to reduce lateral spread and potentially improve margin predictability. Future localisation research should be framed by oncologic endpoints, incorporating systematic reporting of lesion depth, minimal margin distance, and longitudinal local recurrence, alongside multicentre prospective validation within robotic workflows.