Navigational bronchoscopy is the newest and latest addition to the Minimally Invasive Thoracic Surgery Programme at NHCS, that allows more accurate surgery of lung nodules.

​By Asst Prof Soo Ing Xiang, Consultant, Thoracic Surgery, Department of Cardiothoracic Surgery

Between 2013 and 2017, there were close to 8,000 lung cancers diagnosed in Singapore which was about four cases a day1. Lung cancer has a higher fatality rate as compared to breast or colon cancer; with more than three deaths a day. While smoking is found to be the main risk factor for lung cancer, there has been an increase in lung cancer for nonsmokers, especially in the Asian population. Unfortunately in lung cancer, there are generally no symptoms during its early stages, and it is often only picked up through health screening or body check. Nonetheless, surgery can offer a chance of a cure if treated in its early stages.

VATS for Lung Cancer

Keyhole lung surgery, or also known as Video-Assisted Thoracoscopic Surgery (VATS) is a less invasive technique for lung surgery, and has become the standard of care at NHCS, as it helps to reduce postsurgery pain and aid in faster recovery. 

NHCS performs about 600 cases of VATS annually with majority for lung cancer. Traditionally, lobectomy (surgery to remove one of the lobes of the lung) or major resection of the lung is needed for treatment of lung cancer. However, recent  research2-3 suggests a lesser resection for smaller lung cancer could result in equivalent cure rates and increase preservation of lung function.

In traditional bronchoscopy, a small light and camera are mounted on a thin, flexible fibre-optic cable to check the airways of the lungs through the patient’s nose or mouth. The procedure provides direct visuals of the throat and airways.

In navigation bronchoscopy, a special cable is used with the combination of real-time electromagnetic navigation (GPS-like technology) and computed tomography (CT) images, to locate even the smallest lung nodules, and allow more accurate localisation of the cancer. During a surgery, doctors will use navigational bronchoscopy to virtually map out the patient’s airway, and plan a pathway to the cancer. Once they ‘navigate’ their way precisely to the lung cancer, they will mark it with a special fluorescent dye to locate the exact site of the cancer. Through this, doctors are able to make precise resections of the lung and avoid cutting excessive lung tissue to remove the cancer, thus preserving more lung for the patient.

Besides the precision and accuracy offered by the technology, navigational bronchoscopy also helps to save time. The localisation and removal of multiple cancers can be done in one setting, compared to conventional localisation where it may take more than one procedure. This reduces time and costs needed for repeat procedures.

Barely visible wound (arrow) after VATS.

In summary:

  • If detected in the early stage, surgery can offer a chance of a cure for lung cancer

  • VATS together with lung preservation techniques, help patients regain functional capacity after surgery, leading to better patient outcomes

  • Navigational bronchoscopy can be used for precise lung resection in the same setting to further preserve lung function

1. Singapore ICA Report on Registration of Births and Deaths 2019

2. Saji H, Okada M, Tsuboi M, Nakajima R, Suzuki K, Aokage K, Aoki T, Okami J, Yoshino I, Ito H, Okumura N, Yamaguchi M, Ikeda N, Wakabayashi M, Nakamura K, Fukuda H, Nakamura S, Mitsudomi T, Watanabe SI, Asamura H. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet. 2022 Apr 23; 399(10335):1607-1617

3. National Comprehensive Cancer Network Guidelines for Non-Small Cell Lung Cancer 2021

This article is from Murmurs Issue 42 (January – April 2022). Click here to read other articles or issues.