Efficacy and safety of the RC120 navigation system for the computed tomography-guided localization of pulmonary ground-glass nodules: a prospective study with historical controls

Introduction

Lung cancer persists as one of the leading causes of cancer mortality worldwide, and early-stage detection of this disease is becoming increasingly reliant on low-dose computed tomography (CT) screening (1,2). When ground-glass nodules (GGNs) are discovered, patients frequently experience significant anxiety that can substantially interfere with their daily lives. Video-assisted thoracoscopic surgery (VATS) has emerged as the technique of choice for inclusion in the diagnostic and therapeutic strategies that manage pulmonary GGNs. These characteristic pulmonary abnormalities, frequently indicative of adenocarcinoma spectrum pathology, pose substantial challenges for surgeons attempting precise intraoperative localization during thoracoscopic procedures.

During surgery, accurately identifying small pulmonary GGNs—especially those smaller than 10 mm in diameter or located more than 5 mm from the pleural surface—is considerably difficult, rendering traditional finger palpation methods largely inadequate. Contemporary CT-guided localization techniques involving hook-wires, microcoils, or dye markers have considerable limitations due to both procedure-related complications and technical barriers including respiratory motion and bone interference (3-6). To address these difficulties, innovative technologies featuring robotic navigation capabilities have been developed, with the complementary objectives of enhancing localization precision and minimizing procedure-associated complications.

Despite advancements being achieved in navigation technology, both optical and electromagnetic systems have distinct operational weaknesses. The recently developed RC120 navigation system (Shanghai Simple Touch Technology Co., Ltd.)—approved by China’s National Medical Products Administration—represents an integration of CT imaging with trajectory planning, thus eliminating the need for manual calibration processes and external markers. Although the RC120 system was previously validated for percutaneous needle biopsy, no literature exists on the clinical application of this navigation system in preoperative pulmonary GGN localization. Therefore, the aim of this study was to perform the first real-world evaluation of the RC120 system’s clinical utility exclusively for preoperative localization performance. For the assessment of its efficacy and safety, a prospective cohort in which the procedures were performed by a surgeon with no prior experience in CT-guided percutaneous interventions was compared to a historical control cohort in which the procedures were performed by experienced surgeons. Procedural success, efficiency, and the learning curve for the novice operator were examined. We present this article in accordance with the TREND reporting checklist (available at https://qims.amegroups.com/article/view/10.21037/qims-2026-1-0300/rc).

Methods

Ethical statement

This study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. It was approved by the Ethics Committee of The Third Affiliated Hospital of Sun Yat-sen University, China (approval No. II2024-285-02), and was registered at ClinicalTrials.gov (registration No. ChiCTR2500105233). Informed consent was obtained from all participants.

Study design

In this study, a prospective interventional cohort was compared to a historical retrospective control cohort from the same center. Patients with peripheral GGNs (>5 mm from the pleura) with highly suspected early-stage lung cancer treated at The Third Affiliated Hospital of Sun Yat-sen University were enrolled. These patients were evaluated by two expert thoracic surgeons. Other inclusion criteria were age 18–80 years and a maximum tumor diameter ≤20 mm. The exclusion criteria were coagulopathy, severe cardiopulmonary insufficiency, severe liver or kidney dysfunction, scapular obstruction preventing puncture, and pregnancy. The flowchart of patient inclusion is shown in Figure 1.

Figure 1 Flowchart of patient enrolment. CT, computed tomography; GGNs, ground-glass nodules; VATS, video-assisted thoracoscopic surgery.

To rigorously evaluate the clinical efficacy and learning curve of the navigation system, we established two cohorts for comparison. The intervention group consisted of 39 patients prospectively enrolled between July 2024 and January 2025 who underwent RC120-assisted localization performed exclusively by a single surgeon with no prior experience in CT-guided percutaneous interventions. For the control group, we retrospectively reviewed our institutional electronic medical records to identify 138 consecutive patients who met the same inclusion and exclusion criteria as those of the intervention group and who underwent conventional free-hand localization by two experienced surgeons (each with over 5 years of clinical experience with this technique) between November 2021 and October 2023.

Those who met all the inclusion criteria underwent RC120-assisted CT-guided percutaneous pulmonary lesion/nodule localization (PPLN). The surgical protocol was conducted according to the Chinese consensus on percutaneous biopsy of thoracic tumors (7). The study included three follow-up assessments: the first within 24 hours of localization, the second during and within 24 hours after VATS wedge resection, and the third 24–72 hours after resection. After follow-up, clinical data were collected and analyzed.

RC120 localization procedure

The RC120 navigation system (Shanghai Simple Touch Technology Co., Ltd., Shanghai, China) mainly includes an operating bed, mainframe, robotic arm, control cabinet, and foot switches (Figure 2). The system features a proprietary architecture based on the integration of CT imaging and intelligent sensing technology. Rather than relying on external tracking hardware or patient-mounted markers, this “registration-free” approach uses a proprietary precalibrated coordinate mapping mechanism. As detailed in a previous multicenter validation study (8), the system relies on an intrinsic, fixed spatial relationship established between the robotic mainframe and the imaging environment during initial installation. Upon importing the initial CT scan, the system’s algorithm extracts embedded spatial reference parameters directly from the Digital Imaging and Communications in Medicine (DICOM) data to automatically calculate the rigid transformation matrix between the CT image coordinate system and the physical space of the robot. This precalibrated geometric linkage maps the virtually planned trajectory onto the physical space, thereby eliminating the need for intraprocedural manual registration steps such as optical surface marker placement or point-pair matching. The procedure for localization is illustrated in Figure 3.

Figure 2 Structural diagram of the RC120 navigation system.

Figure 3 The workflow of RC120-assisted pulmonary nodule puncture localization. The black arrow indicates the workflow of this navigation system, and the red dashed arrow indicates that the needle needs to be adjusted when the localization is not satisfactory and then confirmed by a CT scan. CT, computed tomography; NG, no good.

During the PPLN procedure, patients underwent vacuum cushion stabilization to prevent movement and then underwent an initial CT scan via a 64-slice Aquilion TSX-101A device (Toshiba, Kawasaki, Japan), with 100 kV, 120 mAs, and a 1-mm slice thickness) in the CT room. When CT image data in DICOM format are imported, the RC120 client software produces a three-dimensional (3D) visualization. The operator then identifies the target and plans the shortest puncture path on the CT images to establish a needle trajectory. Needle trajectories avoiding vasculature were planned via 3D reconstruction in our study. After the operator confirms the planned trajectory, the system calculates the motion paths for both the mainframe and robotic arm. Once these paths are verified, the operator initiates the procedure using a foot pedal, prompting the autonomous movement of the mainframe and robotic arm to their designated positions. The operator performs a secondary check of the RC120 arm’s position and then inserts the puncture needle along the guide groove to complete the localization. Therefore, a second CT scan was performed in our study to verify whether the tip of the puncture needle reached the intended target position. If the tip of the puncture needle did not reach the intended position, the operator adjusted the angle or depth of the puncture needle. After confirming the correct position with a CT scan, the safety latch of the puncture needle was removed, the push rod was pressed to release the four-hook anchor, the puncture needle was withdrawn, and the puncture site was bandaged. A repeat CT scan was immediately performed to confirm the position of the anchor and check for complications such as pneumothorax or hemothorax (Figure 4).

Figure 4 A patient with a peripheral pulmonary ground-glass nodule in the right upper lung who underwent operation with RC120 navigation system-assisted pulmonary nodule puncture and positioning. The operation included position fixing, path planning, puncture needle insertion, rescanning to confirm the position of the needle tip, release of the positioning hook, and rescanning to confirm the position of the positioning hook.

Surgical procedure

All patients underwent single-port VATS wedge resection with laryngeal mask anesthesia within 24 hours of localization in the operating room. During surgery, surgeons evaluated whether the localization device remained properly positioned and determined target nodule depth by examining the color and visible length of the tricolored suture exterior to the pleural surface. Using sponge forceps, surgeons measured the surgical margin distance and marked resection boundaries with an electric coagulation hook prior to performing wedge resection with Endo GIA linear staplers (Medtronic, Minneapolis, MN, USA). Immediately after the specimen was incised, the distance from the anchor mechanism to the nodule border was documented (Figure 5). Specimens subsequently underwent rapid frozen pathological assessment.

Figure 5 A patient with a peripheral ground-glass nodule in the right lower lung who underwent single-port thoracoscopic wedge resection under laryngeal mask anesthesia. During the operation, the depth of the nodule was evaluated by the scale line, and the resection margin distance was estimated by the oval forceps. The safety margin was measured after resection.

For this study, we employed a specialized four-hook soft-wire puncture needle (20 G ×100 mm; Ningbo Shengjiekang Biotechnology Co., Ltd., Ningbo, China). The device’s structural features and procedural implementation are illustrated in Figures 6,7, respectively.

Figure 6 The structural features of the four-hook soft-wire puncture needle, including needle tube, protective tube, push device, buckle, anti-strike firing clasp, four-hook anchor, and localization line.

Figure 7 The process of using the new puncture needle for locating pulmonary nodules.

Study endpoints and outcome measurements

The primary endpoint was the overall procedural success rate, defined as the proportion of procedures in which the needle tip was positioned within 10 mm of the target nodule’s border as verified on the final confirmation CT scan.

The secondary endpoints were the following: (I) localization time, measured as the minutes from the initiation of the planning CT scan to the completion of the final confirmation scan; (II) number of needle adjustments required to reach the target; (III) cumulative radiation exposure, quantified as the dose-length product (DLP; mGy·cm); (IV) total number of CT scans performed during the procedure; and (V) safety, which was considered to be the incidence of procedure-related adverse events (AEs).

Needle-to-target deviation was evaluated as a key performance indicator. On the confirmation CT scan, an independent radiologist used multiplanar reconstruction (MPR) to identify the geometric center of the deployed four-hook anchor and the target point across axial, coronal, and sagittal planes. The 3D Euclidean distance between the anchor center and the predetermined target point was then calculated and recorded as the localization error.

Data management

A staff member was designated to conduct data entry throughout the investigation to ensure that the clinical trial information remained authentic and complete. Quality assurance involved cross-verification of case report documentation against source medical records by monitoring personnel. Upon completion of data collection, the research team conducted a collaborative review before database lockdown and implemented secure storage protocols to safeguard against data compromise.

Statistical analysis

Continuous variables were initially assessed for normality via the Shapiro-Wilk test. Normally distributed data are expressed as the mean ± standard deviation (SD) and were compared with the Student t-test. Nonnormally distributed data are expressed as the median with interquartile range (IQR) and were compared with the Mann-Whitney U test. Meanwhile, categorical variables are presented as frequencies and percentages and were compared with the Fisher exact test. For the learning curve analysis in the prospective cohort, Spearman rank correlation (r_s) was used to assess the relationship between chronological case sequence and procedural variables. Comparisons between the initial learning phase and the proficiency phase were conducted via the Student t-test or the Mann-Whitney U test, as appropriate. A two-sided P value <0.05 was considered statistically significant. Statistical analyses were performed with R version 4.5.3 (The R Foundation for Statistical Computing, Vienna, Austria).

Results

Patient characteristics

A total of 177 patients were included in this study, among whom 39 were in the prospective RC120 intervention cohort and 138 in the retrospective conventional control cohort. A detailed flowchart of patient screening and enrolment is provided in Figure 1 and indicates all screened patients and reasons for exclusion. Importantly, no procedures were aborted due to technical failures postenrolment, and all targeted nodules ultimately proceeded to resection.

The baseline characteristics of patients are summarized in Table 1. The intervention cohort and control cohort were well-balanced in terms of key demographic and nodule parameters, including median age (49.0 vs. 52.5 years, P=0.61), gender (P=0.85), median lesion size (8.0 vs. 8.0 mm; P=0.38), lesion density (P=0.92), and median nodule depth from the pleura (9.4 vs. 10.2 mm; P=0.97). However, statistically significant differences were observed in nodule type, with a higher proportion of mixed ground-glass opacities (mGGOs) compared to pure ground-glass opacities (pGGOs) in the intervention group (56.4% vs. 37.7%; P=0.044). Additionally, patient positioning differed significantly, as the lateral position was only used in the intervention group (25.6% vs. 0.0%; P<0.001).

Localization, surgical, and learning curve outcomes

As detailed in Table 2, the primary endpoint—the strictly defined overall procedural success rate (successful deployment of the anchor within 10 mm of the target nodule’s border)—was high in both cohorts and demonstrated no statistically significant difference between intervention group (32/39, 82.1%) and the control group (128/138, 92.8%) (P=0.062). Of the seven cases in the RC120 group that did not meet the strict 10-mm success criterion, the anchor was deployed within 10–17 mm from the target in all instances, and the localization was still deemed clinically adequate for guiding successful wedge resection. No case required conversion to thoracotomy or additional localization procedures. In the intervention group, the needle-to-target deviation (measured via MPR as the Euclidean distance) was 4.8±2 mm.

Although all procedures in the intervention group were operated entirely by a novice surgeon, this group exhibited significant improvements across key secondary efficiency metrics as compared to the expert-operated control group; the median localization time was significantly shorter [15.0 (IQR: 13.0–21.0) vs. 20.5 (IQR: 17.0–26.0) min; P<0.001], and the median number of needle adjustments was significantly reduced to zero [0 (IQR: 0–1) vs. 2 (IQR: 1–3); P<0.001]. Consequently, the RC120 system significantly minimized the median number of requisite CT scans [3 (IQR: 3–4) vs. 5 (IQR: 4–6); P<0.001] and reduced the median cumulative radiation dose [DLP: 913.6 (IQR: 854.2–1,072.4) vs. 1,091.4 (IQR: 900.4–1,515.2) mGy·cm; P=0.003].

Regarding patient-reported pain, the median visual analog scale (VAS) scores were comparable between the cohorts (3.0 vs. 4.0; P=0.02). An exploratory analysis within the intervention group revealed that patients requiring oral nonsteroidal anti-inflammatory drugs (20.5%) did not differ significantly from those not requiring them in terms of nodule depth, procedure time, or number of needle adjustments (all P-values >0.05), suggesting that postprocedural pain is likely more dependent on individual patient factors than on the navigation technique itself.

To address the generalizability and operational mastery of the RC120 system, a learning curve was plotted for the 39 consecutive cases performed by the novice surgeon (Figure 8). Spearman rank correlation analysis revealed no significant correlation between chronological case sequence and localization time (r_s=0.072; P=0.66) or for the number of needle adjustments (r_s=–0.263; P=0.11). To further quantify this, cases were divided into an initial learning phase (cases 1–10) and a plateau phase (cases 11–39). An independent t test indicated no significant difference in localization time between the novice’s first 10 cases and the subsequent proficient cases (15.4 ± 5.1 min vs. 16.3 ± 4.7 min; P=0.61); similarly, the median number of needle adjustments was consistently minimal across both phases (0.5 vs. 0; P=0.48). These robust statistical findings suggest that the RC120 system facilitates a rapid acquisition of proficiency, effectively shortening the traditional learning phase.

Figure 8 Learning curve analysis of the novice operator using the RC120 system. The graph displays the performance metrics across the 39 consecutive prospective cases. The dashed horizontal line indicates the overall mean localization time. Trend lines are fitted for both metrics. Spearman rank correlation analysis showed no significant association between case sequence and localization time (r_s=0.072; P=0.66) or the number of needle adjustments (r_s=–0.26; P=0.11), and there is a flattened learning curve, indicating proficiency was achieved from the initial cases. min, minutes.

Surgical and safety outcomes

All patients successfully underwent single-port VATS wedge resection on the same day of localization or the day after it. The median distance from the anchor to the nodule edge evaluated intraoperatively was 6.5 mm in the intervention group and 3.0 mm in the control group (P<0.001). Importantly, all targeted nodules were successfully resected with negative margins. For malignant lesions, the median resection margin distance was comparable between the intervention and control groups (16.0 vs. 15.0 mm; P=0.09). The vast majority of cases achieved an absolute margin distance ≥5 mm or a margin greater than the nodule diameter, fulfilling the oncological safety criteria established by the Japan Clinical Oncology Group (JCOG) 0802 trial (9).

As detailed in Table 3, the overall safety profile was favorable, with no severe AEs observed in either cohort. Although AEs are inherently associated with the percutaneous pleural puncture—resulting from both the physical traversal of the needle and the planned trajectory—the RC120 navigation system demonstrated a clear safety benefit regarding hemorrhage. Specifically, the RC120 intervention group had a significantly lower rate of hemothorax compared to the free-hand control group (2.6% vs. 21.0%; P=0.006), and the incidence of pneumothorax did not differ significantly between the groups (15.4% vs. 8.0%; P=0.22). There were no cases of hemoptysis in either cohort, and no anchor displacement occurred in the RC120 intervention group, while there were two cases (1.4%) in the control group (P>0.99). All AEs were mild and successfully managed with conservative observation.

Discussion

This study evaluated the clinical performance of the novel RC120 navigation system. A prospective cohort, whose procedures were performed by a novice, was compared to a historical cohort, whose procedures were performed by experts. The findings suggest that this technology can significantly enhance procedural efficiency and safety, thereby potentially lowering the technical barrier for preoperative PPLN.

Clinical relevance and comparison with alternative techniques

VATS has become the preferred technique for diagnosing and treating early-stage lung cancer (9). Meanwhile, conventional methods such as finger palpation are often unable to accurately locate GGNs, making preoperative PPLN essential. Researchers have developed numerous localization materials, including methylene blue dye, indocyanine green, hook-wire systems, and microcoils (4,5). Although dyes are widely used, they suffer from tissue diffusion and lack tactile feedback (6,10). Meanwhile, microcoil placement often requires hybrid operating rooms and fluoroscopy, presenting logistical limitations (11).

Bronchoscopic marking techniques have recently emerged as a promising approach. Virtual-assisted lung mapping (VAL-MAP) and electromagnetic navigation bronchoscopy (ENB)-guided dye or indocyanine green injection allow for simultaneous bronchoscopic evaluation and transbronchial marking without pleural puncture; theoretically, this can prevent pneumothorax and the rare but potentially catastrophic air embolism associated with percutaneous approaches (12-14). In addition, intraoperative CT or hybrid operating room-based localization allows for real-time image guidance and one-stage localization-resection workflows (11). However, several drawbacks hinder their broader applicability. VAL-MAP and ENB marking requires dedicated bronchoscopic equipment and advanced operator skills; moreover, peripheral tiny nodules may not be reachable via the airway, and dye diffusion or fading over time can compromise surgical identification (14,15). Crucially, these techniques generally do not provide the sustained tactile feedback of a rigid metal anchor—a key asset when the surgeon dissects deep, no-palpable GGNs. Intraoperative CT or hybrid operating room strategies may extend operative time and occupy valuable hybrid suite spaces, making them less viable in many centers.

A percutaneous hook-based strategy, especially when executed with a robot-assisted system, is clinically advantageous for several reasons. It provides not only a visible landmark but also continuous rigid tactile feedback along the wire’s entire length, which directly informs wedge resection depth and margins; moreover, the four-hook needle resists dislodgement more effectively than do conventional hook wires (the anchor displacement rate was 0% in our RC120 cohort), mitigating the historical concern of hook-wire dislodgement (16,17). The RC120 system’s registration-free, precalibrated architecture eliminates the line-of-sight and magnetic distortion limitations of optical and electromagnetic navigation, respectively, while the dramatic reduction in needle adjustments and procedure time likely reduces the risk of severe complications. Concomitantly, the system lowers the technical barrier such that even a novice operator can achieve precise localization safely in a standard CT suite—without the need for bronchoscopy platforms or hybrid operating rooms.

Clinically, this technology may be preferred for (I) solitary or multiple small GGNs requiring wedge resection for which tactile guidance is deemed essential (e.g., deep nodules with a large distance to the visceral pleura); (II) centers that lack bronchoscopic navigation equipment or hybrid operating room access; (III) cases in which the airway route is predicted to be challenging (e.g., extreme peripheral or apical lesions); and (IV) scenarios demanding rapid, highly reproducible localization with minimal platform setup. Bronchoscopic marking techniques may serve as a complementary option for centrally located nodules requiring concurrent bronchoscopic biopsy or for when complete avoidance of pleural puncture is the priority (18).

In this era of evolving localization technologies, the clinical niche for a percutaneous hook-based robotic system warrants discussion. Robotic navigation platforms have shown benefits in streamlining operations and decreasing the incidence complications (8,19). However, optical approaches entail occlusion issues when objects interfere with surgical instruments (8,20), and electromagnetic systems remain vulnerable to distortion from nearby metallic objects (8,21,22). The RC120 system overcomes these limitations through its registration-free, precalibrated coordinate mapping architecture (8). When combined with the innovative four-hook puncture needle—which provides enhanced tissue grip and resists displacement more effectively than do conventional hook wires (23)—the system offers a cost-effective solution for standard CT suites. It provides not only a precise visual marker but also crucial tactile feedback from the rigid wire, which is invaluable for the surgeon during the dissection of deep, nonpalpable GGNs. This synergistic effect was evidenced by the complete lack of anchor displacement observed in our RC120 intervention cohort.

Efficiency, safety, and the learning curve

A key finding of our study is the significant reduction in localization time, needle adjustments, and radiation dose achieved by a novice using the RC120 system, which was highly competitive with the historical performance of experienced surgeons using free-hand techniques. This suggests that the system may help compensate for human inexperience. The lack of significant correlation between chronological case sequence and efficiency metrics suggests that only a minimal learning phase is required for novice operators to achieve stable outcomes. Furthermore, 97.4% of procedures in the RC120 intervention group required two or fewer needle adjustments, exceeding previously reported rates for conventional hook-wire methods (19).

Regarding safety, we recognize that AEs such as pneumothorax and hemothorax are inherent to the entire percutaneous procedure, involving both the guidance system’s planned trajectory and the needle’s physical traversal. Although our pneumothorax rate (15.4%) aligns with known ranges for percutaneous pleural punctures (24), our comparative data revealed a significant benefit: the RC120 intervention group had a substantially lower rate of hemothorax compared to the control group (2.6% vs. 21.0%; P=0.006). This may be directly attributed to the system’s 3D reconstruction capabilities, which allow for meticulous preplanning of needle paths that precisely avoid intercostal vessels and intrapulmonary vasculature. Notably, the numerically higher pneumothorax rate in the RC120 intervention group, despite not being statistically significant (15.4% vs. 8.0%; P=0.22), suggests some caution may be warranted. This observation can likely be explained by the systematic, high-sensitivity detection of even minimal, clinically silent pneumothoraces on the immediate postprocedural CT scan, a standard step of the RC120 workflow. In contrast, the retrospective control group’s data, sourced from medical records, may only capture pneumothoraces that were explicitly documented, and thus trivial cases that required no intervention might have been underreported. Crucially, all cases in both groups were mild and conservatively managed, without any need for chest tube drainage, supporting the clinical safety of the approach.

Notably, we observed a significant difference in patient positioning, with the lateral decubitus position used only in the intervention RC120 group, which differed from the control group (25.6% vs. 0.0%; P<0.001). Rather than a baseline confounding bias, this reflects a distinct clinical advantage of the robotic system. In conventional free-hand localization, operators typically avoid the lateral position because it is inherently less stable; prolonged procedure times exacerbate patient movement and respiratory shifts, making manual needle adjustments extremely difficult and risky. In contrast, the RC120 system’s rapid trajectory calculation, autonomous robotic arm alignment, and significantly shortened overall procedure time effectively mitigate these motion-related risks. Consequently, surgeons are empowered to safely select the optimal and shortest puncture path based purely on anatomical considerations, being unconstrained by traditional patient positioning limitations.

Surgical resection and the role of localization

Our results demonstrated excellent oncological outcomes with adequate absolute resection margins in both cohorts. We recognize that while precise localization is a critical prerequisite for successful minimally invasive resection, the final margin distance is ultimately determined by the surgeon’s intraoperative judgment and surgical technique. The localization system’s role is to reliably and efficiently guide the surgeon to the correct nodule location. Following localization, all patients successfully underwent single-port VATS wedge resection. For malignant lesions, the absolute margin distances were oncologically acceptable according to the criteria established by the JCOG 0802 study (9), which specified a minimum 5 mm safe margin for GGNs ≤20 mm with a consolidation tumor ratio ≤0.25. This reinforces the clinical adequacy of the localization, even in the few cases in which the strict 10-mm deployment criterion cannot be met.

Limitations

This study involved several limitations that should be addressed. First and foremost is the use of a historical, nonrandomized control group. The noncontemporaneous nature of the cohort study, in which procedures were operated by a novice in the prospective cohort and by experts under potentially evolving clinical workflows in the retrospective cohort, might have introduced selection and performance biases. Therefore, our comparative findings should be interpreted cautiously as hypothesis-generating feasibility data rather than as definitive proof of clinical superiority. Second, we employed a single-center design with a relatively small prospective sample size. Third, our follow-up protocol was limited to 72 hours postresection, which might have missed delayed complications. Future studies should incorporate a standard 1 to 2-week follow-up. Fourth, the operating surgeon was not blinded to the localization method during resection, as visual and tactile identification of the anchor is the procedure’s primary intention.

Conclusions

The RC120 navigation system appears to be a feasible and efficient approach for preoperative GGN localization when it is combined with a four-hook needle approach. Based on this preliminary comparative analysis, this method has the potential to lower the technical barrier for novice operators, improve procedural efficiency, and reduce the incidence of certain hemorrhagic complications. These promising findings remain to be more rigorously confirmed in future large-scale, multicenter, randomized controlled trials.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the TREND reporting checklist. Available at https://qims.amegroups.com/article/view/10.21037/qims-2026-1-0300/rc

Data Sharing Statement: Available at https://qims.amegroups.com/article/view/10.21037/qims-2026-1-0300/dss

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-2026-1-0300/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. This study was approved by the Ethics Committee of The Third Affiliated Hospital of Sun Yat-sen University (approval No. II2024-285-02), and informed consent was taken from all individual participants.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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