Optical Navigation Robot-Assisted versus Conventional CT-Guided Localization of Pulmonary Nodules: A Comparison of Efficacy and Analysis of Complication Predictors.

PURPOSE: To compare the efficacy and safety of optical navigation robot-assisted versus conventional CT-guided preoperative localization of pulmonary nodules and to identify predictors of procedure-related pneumothorax and pulmonary hemorrhage. MATERIALS AND METHODS: In this retrospective study, 108 patients scheduled for video-assisted thoracoscopic surgery underwent preoperative CT-guided hook-wire localization, either with optical navigation robot assistance (navigation group, n = 53) or conventionally (conventional group, n = 55). Procedural metrics (first-attempt success rate, wire-to-nodule distance, number of CT scans, radiation dose) and complications were compared. Multivariable logistic regression was performed to identify independent factors associated with pneumothorax and pulmonary hemorrhage. RESULTS: The navigation group demonstrated a higher first-attempt success rate (94.34% vs. 80%; P = .03) and a shorter wire-to-nodule distance (4.09 mm vs. 6.40 mm; P = .03) with fewer CT scans required (3.05 vs. 3.20; P = .03), despite a higher radiation dose (172.37 vs. 124.64 mGy·cm; P < .01). Pneumothorax (39.62% vs. 52.73%; P = .17) and pulmonary hemorrhage (24.53% vs. 21.82%; P = .73) rates did not differ significantly. Multivariable analysis identified greater needle depth in the lung (OR: 0.87), greater chest wall thickness traversed (OR: 0.94) and first-attempt success (OR: 0.13) as protective factors against pneumothorax, while needle proximity to a rib (OR: 9.96) was a risk factor. Traversal of pulmonary vessels was the sole risk factor for pulmonary hemorrhage (OR: 11.93). CONCLUSIONS: Optical navigation robot-assisted localization improves the precision of preoperative pulmonary nodule marking. The identified predictors of complications-needle proximity to a rib and traversal of pulmonary vessels-constitute actionable targets for procedural optimization. LEVEL OF EVIDENCE: Level 3, Non-controlled retrospective cohort study.