Vol. 7, Issue 1, Part A (2025)

Colorectal cancer often spreads to the lungs and distinguishing metastatic nodules from benign or primary lung lesions can be difficult. Modern localization tools such as cone-beam CT (CBCT), radial EBUS and fluorescence-guided techniques have improved accuracy, particularly for small or deep pulmonary nodules. This case highlights the use of these technologies in managing bilateral pulmonary metastases. A 46-year-old woman previously treated for sigmoid adenocarcinoma was found to have enlarging bilateral pulmonary nodules on PET-CT, with increased FDG uptake and no other active disease. Preoperative localization using CBCT, radial EBUS and indocyanine green injection enabled precise intraoperative identification of both lesions. She underwent robotic bilateral metastasectomy, resulting in complete resection of right upper and left lower lobe nodules. Histopathology confirmed metastatic moderately differentiated adenocarcinoma with clear margins. Postoperative recovery was smooth, and she was discharged in stable condition. Advanced imaging-guided localization combined with robotic surgery allows safe, accurate resection of bilateral pulmonary metastases while preserving lung function.