• Wanlan Fang, Jisong Zhang, Enguo Chen, and Kejing Ying.
• Department of Respiratory and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Diseases, Sir-Run-Run-Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
• Medicine (Baltimore). 2024 Sep 20; 103 (38): e39805e39805.

RationalePulmonary ground-glass nodules (GGNs) pose challenges in intraoperative localization due to their primarily nonsolid composition. This report highlights a novel approach using H-marker deployment guided by LungPro navigation combined with cone-beam computed tomography (CBCT) for precise localization of multiple GGNs.Patient ConcernsA 55-year-old female patient presented at Sir-Run-Run-Shaw Hospital, Zhejiang University School of Medicine, in June 2021, requiring thoracoscopic surgery for the management of multiple GGNs in her right lung. She had a recent history of thoracoscopic wedge resection for a lesion in her lower left lung 3 months prior.DiagnosesComputed tomography scans revealed the presence of 3 mixed GGNs in the right lung, with further confirmation identifying these as solitary pulmonary nodules, necessitating surgical intervention.InterventionsThe patient underwent thoracoscopic surgery, during which the multiple nodules in her right lung were precisely localized utilizing an H-marker implanted bronchoscopically under the guidance of LungPro navigation technology, with CBCT providing additional confirmation of nodule positioning. This innovative combination of technologies facilitated accurate targeting of the lesions.OutcomesPostoperative histopathological analysis confirmed the nodules to be microinvasive adenocarcinomas. Radiographic examination with chest X-rays demonstrated satisfactory lung expansion, indicating effective lung function preservation following the procedure. Follow-up assessments have shown no evidence of tumor recurrence, suggesting successful treatment.LessonsThe employment of H-marker implantation guided by the LungPro navigation system with CBCT confirmation presents a feasible and efficacious strategy for localizing multiple pulmonary GGNs. To further validate its clinical utility and safety, large-scale, multicenter, prospective studies are warranted. This approach holds promise in enhancing the precision and outcomes of surgeries involving GGNs.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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