Robotic One Anaesthetic Marking And Resection (ROMAR): A Novel Approach for Thoracoscopic Sublobar Resection of Peripheral Pulmonary Lesions.

[BACKGROUND AND OBJECTIVES] Small lung nodules can be difficult to identify via thoracoscopy, thereby making thoracoscopic sublobar resection challenging. We have developed a protocol of preoperative lung nodule marking using robotic-assisted bronchoscopy (RAB), followed by thoracoscopic sublobar resection in one setting. We evaluated the outcomes of patients undergoing Robotic One Anaesthetic Marking And Resection (ROMAR).

[METHODS] We reviewed the records of all patients undergoing ROMAR between January 2023 and March 2025. The primary outcome was the success of marking, defined as dye visualisation on the pleural surface during thoracoscopy and the resected specimen containing the lesion.

[RESULTS] A total of 119 lesions in 111 patients were included. The mean lesion size was 14.2 mm (SD ± 5.9 mm). The majority of the lesions (77.3%) were non-solid. An average of 1.0 cc of dye was injected per target. RATS and VATS were performed in 77 and 31 patients, respectively. The initial resection procedures were wedge resection in 94 patients (84.7%), segmentectomy in 16 patients (14.4%), and lobectomy in 1 patient (due to adhesions). In 6 cases, dye was not visible on the pleural surface during thoracoscopy. In 5 patients (4.5%), no tumour was identified on the initial frozen section. Therefore, initial sublobar resection was successful in 99 patients (89.2%). No significant complications were noted.

[CONCLUSIONS] ROMAR facilitated successful thoracoscopic sublobar resection of small lung nodules in approximately 90% of the cases. It is safe and can be easily adopted at most centres performing robotic bronchoscopy and thoracoscopic lung surgery.