To develop a novel thoracoscopic magnetic navigation-guided puncture-free global localization (TMPGL) technique based on magnetic navigation, 3D reconstruction, and bony landmarks.

Preoperative CT scanning was performed in the supine or lateral position, followed by 3D reconstruction to develop the strategy and plan the approach. The first rib-sternocostal joint, the fourth rib-vertebra joint, and the seventh rib-vertebra joint were selected as bony landmarks. CT-guided puncture localization was also performed. Intraoperatively, spatial coordinates were calibrated by touching the bony landmarks with a magnetic navigation probe, which then guided the probe to a virtual localization point on the chest wall where methylene blue dye was applied. After lung inflation, the dye was passively transferred to the visceral pleura, thereby achieving accurate localization of the lung nodule.

Both CT-guided puncture localization and TMPGL were successfully performed. TMPGL demonstrated significant advantages over puncture localization in terms of time, deviation from the target point, and distance from the nodule (P<0.001, P=0.025, P=0.039, respectively). During puncture localization, 9 patients (69.23%) developed complications of varying degrees, including bleeding (53.80%), pneumothorax (30.77%), and chest wall hematoma (23.08%). The median postoperative pain visual analogue scale (VAS) score was 3, with 3 patients (23.08%) experiencing pain lasting more than 30 minutes. No significant differences were observed in terms of time, deviation, distance from the nodule, or dye spread distance between the two body position groups in TMPGL (all P>0.05).

The TMPGL technique significantly outperforms conventional puncture localization in terms of time, accuracy, and distance from the nodule. It enables precise targeting of peripheral, mediastinal, and diaphragmatic lung nodules-regions that are challenging for traditional puncture-based approaches-providing a safe, efficient strategy for accurate localization in early-stage lung cancer.