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<p>Preoperative localization of pulmonary nodules is critical for video-assisted thoracoscopic surgery (VATS). Traditional Computed Tomography (CT)-guided localization has limitations, including radiation exposure and procedural complexity. Mixed Reality (MR)-guided localization offers a promising alternative, potentially improving accuracy, efficiency, and safety. To compare the accuracy, efficiency, and safety of MR-guided versus CT-guided preoperative localization for pulmonary nodules in VATS through a noninferiority randomized trial. This prospective, single-center, noninferiority randomized clinical trial enrolled 90 patients with small pulmonary nodules. Patients were randomized to either MR-guided or CT-guided localization groups. The primary outcome was localization accuracy, measured by deviation from the target nodule. Secondary outcomes included procedural duration, insertion attempts, radiation exposure, complications, and surgical outcomes. Intention-to-treat (ITT) and per-protocol (PP) analyses were both performed. The MR-guided group demonstrated significantly higher localization accuracy, with smaller total deviation (5.50&#xa0;mm vs. 6.84&#xa0;mm, <i>p</i> = 0.04) and vertical deviation (<i>p</i> = 0.04). Procedural duration (3.98&#xa0;min vs. 10.73&#xa0;min, <i>p</i> &lt; 0.001) and insertion attempts (1.05 vs. 2.28, <i>p</i> &lt; 0.001) were significantly reduced in the MR-guided group. Radiation exposure was also lower, with fewer CT scans and reduced dose length product and effective dose (<i>p</i> &lt; 0.001). Complication rates, including pneumothorax and hemorrhage, were slightly lower in the MR-guided group but not statistically significant. Surgical outcomes were comparable between groups. MR-guided localization met the noninferiority criteria to CT-guided localization in terms of localization accuracy and overall safety, and showed exploratory clinical benefits with notably improved procedural efficiency and reduced radiation exposure. These findings support its potential as a safe and effective alternative for preoperative pulmonary nodule localization in thoracic surgery.</p>

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Comparison of mixed reality and computed tomography-guided preoperative hook-wire localization for pulmonary nodules in video-assisted thoracoscopic surgery: a noninferiority randomized clinical trial

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月2日

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  • Wenzhe Qi,
  • Juan Zhou,
  • Ning Xin

摘要

Preoperative localization of pulmonary nodules is critical for video-assisted thoracoscopic surgery (VATS). Traditional Computed Tomography (CT)-guided localization has limitations, including radiation exposure and procedural complexity. Mixed Reality (MR)-guided localization offers a promising alternative, potentially improving accuracy, efficiency, and safety. To compare the accuracy, efficiency, and safety of MR-guided versus CT-guided preoperative localization for pulmonary nodules in VATS through a noninferiority randomized trial. This prospective, single-center, noninferiority randomized clinical trial enrolled 90 patients with small pulmonary nodules. Patients were randomized to either MR-guided or CT-guided localization groups. The primary outcome was localization accuracy, measured by deviation from the target nodule. Secondary outcomes included procedural duration, insertion attempts, radiation exposure, complications, and surgical outcomes. Intention-to-treat (ITT) and per-protocol (PP) analyses were both performed. The MR-guided group demonstrated significantly higher localization accuracy, with smaller total deviation (5.50 mm vs. 6.84 mm, p = 0.04) and vertical deviation (p = 0.04). Procedural duration (3.98 min vs. 10.73 min, p < 0.001) and insertion attempts (1.05 vs. 2.28, p < 0.001) were significantly reduced in the MR-guided group. Radiation exposure was also lower, with fewer CT scans and reduced dose length product and effective dose (p < 0.001). Complication rates, including pneumothorax and hemorrhage, were slightly lower in the MR-guided group but not statistically significant. Surgical outcomes were comparable between groups. MR-guided localization met the noninferiority criteria to CT-guided localization in terms of localization accuracy and overall safety, and showed exploratory clinical benefits with notably improved procedural efficiency and reduced radiation exposure. These findings support its potential as a safe and effective alternative for preoperative pulmonary nodule localization in thoracic surgery.