J.Jpn. Surg. Soc.. 127(1): 28-33, 2026

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Feature topic

LOCALIZATION TECHNIQUE WITH A RFID SYSTEM IN PRECISE SUBLOBAR RESECTION FOR SMALL LUNG NODULES

Recent lung cancer guidelines have positioned sublobar resection, i.e., wedge resection and segmentectomy, as standard surgical options for tumors ≤2 cm. While thoracotomy allows lesion localization and margin assurance by palpation, video-assisted thoracoscopic and robot-assisted thoracic procedures, which are the most common procedures for lung cancer resection in Japan, require reliable pre- or intraoperative marking.
In this article, we describe the development, clinical implementation, and remaining challenges of an RFID marker system in minimally invasive resection of small lung cancers. We engineered and iteratively refined a workflow that enables precise placement of a small RFID tag near the target nodule under image guidance including a cone-beam CT-guiding or endobronchial navigational bronchoscope, followed by intraoperative detection with a dedicated antenna/probe. The system is integrated with preoperative segmental planning to define resection lines and to verify surgical margins during VATS or RATS. Our experience and accumulated reports indicate that RFID guidance is feasible for localizing nonpalpable or subpleural-distant lesions and for supporting margin verification during wedge resection and segmentectomy. Priorities for further work include optimizing deployment accuracy for deep or ground-glass-predominant nodules, minimizing migration risk, and establishing cost-effectiveness. These efforts will help define the role of RFID in contemporary sublobar resection strategies.

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