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━━ Background. It has recently been suggested that virtual-assisted lung mapping (VAL-MAP) may enable more reliable and safer intraoperative navigation than conventional preoperative lung marking strategies. We herein report a case of thoracoscopic wedge lung resection of small-sized ground-glass nodules (GGNs) using VAL-MAP. Case. A 63-year-old man who had undergone treatment for prostate cancer presented with two smallsized peripheral GGNs in the right upper lobe. A follow-up chest CT scan of the patient nine months later demonstrated an increase in the size of the two GGNs. Due to the patient’s severe renal insufficiency, we decided to perform thoracoscopic wedge lung resection using VAL-MAP. Intraoperatively, four blue markings were clearly visible on the right upper lobe, and the two lesions were successfully resected with single wedge resection along the markings as Merkmal. The pathological diagnosis was adenocarcinoma in situ. The patient’s postoperative course was uneventful, and he remains well after one year, with no evidence of recurrence. Conclusions. We herein reported a case of thoracoscopic wedge lung resection of small-sized GGNs that was performed using VAL-MAP. VAL-MAP is a novel and useful strategy for detecting small-sized peripheral lung lesions with a high degree of reliability and safety. (JJLC. 2015;55:206-211) KEY WORDS━━ Virtual-assisted lung mapping (VAL-MAP), Ground-glass nodule (GGN), Wedge lung resection, Adenocarcinoma in situ Received February 5, 2015; accepted June 1, 2015. 要旨━━背景.従来の術前肺マーキング法と異なり,複 数個所にマーキングを施し,肺に「地図」を描くバーチャ ル気管支鏡ナビゲーションを利用した術前気管支鏡下肺 マッピング法(VAL-MAP)には,より確実・安全な手術 支援が期待される.VAL-MAPを用い,微小なGGNに対 して完全鏡視下切除を行った症例を報告する.症例.63 歳男性.前立腺癌の術前精査のために撮影された胸部 CTで,右肺上葉の胸膜直下にGGNを 2ヵ所指摘され, 当科紹介となった.9ヵ月後の胸部CTで GGNの増大を 認め,手術による切除の方針とした.末期腎不全患者で あり,VAL-MAPを用いた肺部分切除の適応とした.手 術は 3ポートによる完全鏡視下手術で行った.右肺上葉 に 4ヵ所のマーキングを確認し,それらをメルクマール とし,2つの病巣をそれぞれ部分切除した.それぞれの切 除標本内に病変を確認し,手術終了とした.術後経過は 良好であった.永久病理診断はともに adenocarcinoma 1公益財団法人田附興風会医学研究所北野病院呼吸器外科;2京 都大学医学部呼吸器外科. 受付日:2015 年 2 月 5 日,採択日:2015 年 6 月 1 日. (肺癌.2015;55:206-211) 2015 The Japan Lung Cancer Society Wedge Resection of Small-sized Ground-glass Nodule Using Virtual-assisted Lung Mapping―Yamanashi et al Japanese Journal of Lung Cancer―Vol 55, No 4, Aug 20, 2015―www.haigan.gr.jp 207 Figure 1. Chest CT showed two small-sized peripheral ground-glass nodules (S1; 4 mm in diameter, S2; 8 mm in diameter). in situであった.術後 1年現在,再発なく経過観察中であ る.結論.従来の術前肺マーキング法と比較してVALMAPは,確実性と安全性を兼ね備えた有用なマーキン グ法であると考えられる. 索引用語━━ Virtual-assisted lung mapping ( VALMAP),Ground-glass nodule(GGN),肺部分切除,Ade-

A Case of Thoracoscopic Wedge Lung Resection of Small-sized Ground-glass Nodules Using Virtual-assisted Lung Mapping