Background: Different approaches are required in treating patients with multiple pulmonary lesions. A multistage procedure may increase the risk of complications and patient discomfort. This study reports an initial experience with single-stage management of multiple lung lesions using percutaneous ablation with thoracoscopic resection in a hybrid operating room (HOR). Methods: We retrospectively evaluated patients who underwent combined ablation and resection in an HOR between May 2022 and July 2024. All patients received a single anesthesia via endotracheal tube intubation. The clinical data, operative findings, and pathological characteristics of the lung nodules were recorded. Results: A total of 22 patients were enrolled in this study. Twenty patients underwent unilateral procedures, while the other two patients underwent bilateral procedures. Ablations were performed before lung resection in 21 patients; only 1 patient underwent surgery first. The median global operating room time was 227.0 min. The median total radiation dose (dose area product) was 14,076 μGym². The median hospital postoperative length of stay was 2 days. Conclusions: The single-stage procedure of percutaneous ablation with thoracoscopic resection under general anesthesia in an HOR is feasible and safe. This procedure is an alternative method for managing multiple pulmonary lesions.

Conventional endobronchial blockers (EBBs) preserve a single-lumen airway but require fiberoptic bronchoscopy (FOB). Blocker Eye integrates imaging, illumination, steering, and continuous cuff-position monitoring. We evaluated its feasibility for porcine one-lung ventilation (OLV). Three swine were studied. In Study 1, three board-certified anesthesiologists, all first-time in vivo users, performed 20 placements in one swine in consecutive device blocks: 10 with Blocker Eye and 10 with a conventional FOB-guided EBB. In Study 2, Blocker Eye provided lung isolation during wedge resection and segmentectomy in two swine. Placement time, procedural interruptions, physiology, and airway histopathology were assessed. In Study 1, OLV-establishment time was shorter with Blocker Eye (median [IQR], 30.9 [20.9-45.3] vs. 60.6 [50.9-71.0] s; exact Mann-Whitney U test, P = 0.009), although the comparison was exploratory and non-independent. In Study 2, both resections were completed, and the operating surgeon considered lung collapse sufficient. No ventilator interruption, rescue FOB, blocker exchange, repositioning, SpO₂ <90%, or high airway pressure requiring intervention occurred; SpO₂ remained 96-100% and end-tidal CO₂ 35-48 mmHg. Grade ≥2 epithelial loss occurred in 5/12 control, 11/12 single-application, and 9/12 repeatedly instrumented fields. Control-adjusted descriptive ISO 10993-6 framework scores were 4.0 for single application and 2.0 for repeated instrumentation. Injury was superficial with mild inflammation, but substantial epithelial loss in one uninstrumented bronchus precluded device-specific attribution. Blocker Eye enabled OLV with continuous endobronchial monitoring and maintained lung isolation during two resections. These preliminary findings support further device refinement and standardized preclinical safety evaluation before clinical testing.

Background/Objectives: Different approaches are required in treating patients with multiple pulmonary lesions. A multistage procedure may increase the risk of complications and patient discomfort. This study provides an initial experience with single-stage management of multiple lung lesions using percutaneous ablation with thoracoscopic resection in a hybrid operating room (HOR). Methods: We retrospectively evaluated patients who underwent combined ablation and resection in a HOR between May 2022 and July 2024. All patients received a single anesthesia via endotracheal tube intubation. Clinical data, operative findings, and pathological characteristics of the lung nodules were recorded. Results: A total of 23 patients were enrolled in this study. Twenty patients underwent unilateral procedures, and the other three patients underwent bilateral procedures. Ablations were performed before lung resection in 22 patients; only one patient underwent surgery first. The median global operating room time was 227.0 min. The median total radiation dose (dose area product) was 14076 μGym2. The median hospital postoperative length of stay was 2 days. Conclusion: The single-stage procedure of percutaneous ablation with thoracoscopic resection under general anesthesia in a HOR is feasible and safe. This procedure is an alternative method for managing multiple pulmonary lesions.