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Page 6 of 8 Dolan et al. Mini-invasive Surg 2021;5:3 I http://dx.doi.org/10.20517/2574-1225.2020.101

Another advancement lies in improved lesion targeting for NSCLC that is not located at the outermost
periphery. Image-guided video-assisted thoracoscopic surgery (iVATS) is an emerging technology
[44]
that is being developed to allow localization of non-palpable lesions . Early reports indicate excellent
rates of localization using modifications of previously developed techniques with wires, microcoils,
and indocyanine green with near-infrared imaging [46-48] . These lesions are then removed with sublobar
resections. Of note, the use of this technology requires a hybrid operating room equipped with a CT
scanner, which is not available at all facilities. By being able to remove deeper lesions while still performing
wedge resection or segmentectomy, iVATS offers high-risk patients another surgical option for lesions that
previously may have required lobectomy.

CONCLUSION
In summary, high-risk patients remain a poorly defined group, with patients typically defined as those with
some degree of poor pulmonary function and often other significant functional or medical limitations.
In these patients, surgical resection is the gold standard relative to SBRT and ablative techniques.
Segmentectomy should be performed rather than wedge resection when feasible, and when lobectomy is
not an option. Future developments in radiomics and iVATS technique may help further refine the optimal
treatment approaches for high-risk patients.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the conception and design of the study, performed data analysis and
interpretation, data acquisition, as well as provided administrative, technical and material support: Dolan D,
Swanson S

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Dr. Swanson reports receipt of honoraria from Covidien and Ethicon for speaking and consulting services.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2021.

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