Thoracic Surgery
Precision guidance for early-stage lung cancer therapy

Image-guided needle insertion in the Hybrid OR

Lung cancer is the second most common cancer in the world. In the U.S. alone, more than 200,000 patients are diagnosed with this asymptomatic disease every year – and often far too late, leading to relatively low chances of survival.1 Regular lung cancer screenings enable physicians to detect tumors at earlier stages during which minimally invasive surgery might be more appropriate. However, when the lesions are small and deep, treatment using conventional two-room workflows can be challenging.2 This is because CT-based needle localization in the interventional suite followed by transfer to the OR involves risks such as needle dislocation, pneumothorax in an environment less safe than the OR itself,3 and patient anxiety during waiting times.

Our imaging systems with procedural intelligence allow you to move ahead by expanding precision medicine in the treatment of lung cancer. Bringing CT-like imaging directly to the OR, ARTIS pheno can visualize even small lesions and distal airways as well as provide guidance throughout the procedure.2,4,5 Standardizing treatment for lung cancer to advance therapy outcomes has never been so firmly within reach.

Thoracic procedures with Hybrid OR imaging solutions

Installed in a Hybrid OR, ARTIS pheno offers a one-stop workflow for the resection of small pulmonary nodules. Dedicated features help you master even the most challenging aspects of treatment6 with image-guided video-assisted thoracoscopic surgery (iVATS)4 and image-guided endobronchial interventions. These approaches combine intraoperative large-volume 3D imaging, guidance followed by minimally invasive resection8, biopsy5, or ablation.9 The unique capabilities of ARTIS pheno enable thoracic surgeons to optimize clinical operations by reducing the overall procedure time10 and the time-at-risk for the patient.11

iVATS procedures in the Hybrid OR

Our one-stop Hybrid OR workflow with ARTIS pheno allows the patient to stay in the Hybrid OR throughout the entire procedure, potentially reducing time-at-risk by up to 94% compared to a CT-based two-room setup.7

Endobronchial biopsy & ablation

Thanks to fast intraoperative 3D imaging with high spatial resolution as well as intraprocedural guidance tools, ARTIS pheno is the ideal system for performing endobronchial interventions.11 You can accomplish extremely precise tumor targeting with an effective lung radiation dose of only approximately 0.4 mSv 5 compared to an effective dose of 1-2 mSv for typical chest CT screenings.12

Our Hybrid OR imaging solutions

Success story: The hybrid approach

Lung cancer is the leading cause of cancer death in Taiwan, affecting even nonsmokers at high rates. Thanks to widespread screenings in the recent past, an increasing number of patients with smaller lung nodules who are otherwise healthy are demanding state-of-the-art treatment for their condition. Chi Mei Medical Center, located in the city of Tainan, is able to provide cutting-edge minimally invasive procedures thanks to a commissioned Hybrid OR equipped with ARTIS pheno. Yao Fong, Head of Thoracic Surgery, says that the high-end robotic imaging system has allowed him and his team to improve lung cancer therapies and develop new treatment approaches.

Interview with Yao Fong, Director of Thoracic Surgery Department, Chi Mei Medical Center, Tainan, Taiwan


Read the whole interview

Scientific Talks and Publications

The statements with footnotes in this document are based on a result of the quoted clinical study that evaluates the procedure. The results are not generated with the actual product version. It is expected, that the actual product version has similar or improved functionality to support the evaluated procedure.

Some/all of the features and products described herein may not be available in the United States or other countries.

1American Cancer Society, “Key Statistics for Lung Cancer” 2018, last revised January 8, 2019,

2Michael Kostrzewa et al., “Computed Tomography-Assisted Thoracoscopic Surgery: A Novel, Innovative Approach in Patients With Deep Intrapulmonary Lesions of Unknown Malignant Status,” Investigative Radiology 52, no. 6 (2017): 374–380,

3Ze-Rui Zhao et al., “Image-Guided Localization of Small Lung Nodules in Video-Assisted Thoracic Surgery,” Journal of Thoracic Disease 8, suppl. 9 (2016): S731–S737,

4Ritu Gill et al., “Image-guided Video Assisted Thoracoscopic Surgery (iVATS): Phase I-II Clinical Trial,” Journal of Surgical Oncology 112, no. 1 (2015): 18–25,

5Wolfgang Hohenforst-Schmidt et al., “Radiation Exposure of Patients by Cone Beam CT during Endobronchial Navigation,” Journal of Cancer 5, no. 3 (2014): 192–202,

6Shun-Mao Yang et al., “Image-Guided Thoracoscopic Surgery with Dye Localization in a Hybrid Operating Room,” Journal of Thoracic Disease 8, suppl 9 (2016): S681–S689,

7Yin-Kai Chao et al., “A Comparison of Efficacy and Safety of Preoperative Versus Intraoperative Computed Tomography-Guided Thoracoscopic Lung Resection,” Journal of Thoracic and Cardiovascular Surgery 156, no. 5 (2018): 1974–1983.e1,

8Ming-Ju Hsieh et al., “Learning Curve of Image-Guided Video-Assisted Thoracoscopic Surgery for Small Pulmonary Nodules: A Prospective Analysis of 30 Initial Patients,” Journal of Thoracic and Cardiovascular Surgery 155, no. 4 (2018): 1825–1832.e1,

9“CUHK Successfully Conducts Asia-Pacific’s First Hybrid Operating Room Non-Invasive Bronchoscopic Microwave Ablation to Treat Lung Cancer,” The Chinese University of Hong Kong, published March 26, 2019,

10Calvin Ng et al., “Hybrid DynaCT Scan-Guided Localization Single-Port Lobectomy,” Chest 147, no. 3 (2015): e76–e78,

11Calvin S.H. Ng et al., “Hybrid DynaCT-Guided Electromagnetic Navigational Bronchoscopic Biopsy,” European Journal of Cardio-Thoracic Surgery 48, suppl. 1 (2015): i87–8,

12Larke, Frederick J. et al., “Estimated Radiation Dose Associated With Low-Dose Chest CT of Average-Size Participants in the National Lung Screening Trial,” American Journal of Roentgenology 197, no. 5 (2011): 1165–1169,

13Compared with CT-based two-room workflow