Anatomical video-assisted thoracoscopic surgery segmentectomies based on the three-dimensional reformation images

Abstract

Segmentectomy was first done in 1939 by Churchill and Belsey in 1939. Video-assisted thoracoscopic surgery (VATS) segmentectomies are still more technically challenging than VATS lobectomies. With the increasing rate of early stage lung carcinomas, the thoracoscopic segmentectomies may have a major role in a near future. Four anatomical VATS segmentectomy videos clips were shared in this study. CT three-dimensional reformation could exactly show the small pulmonary nodule's precise position, clarifies the surrounding structures' relationship like the pulmonary artery (PA), pulmonary vein (PV), bronchus (B), fissure, and lymph nodes. Besides, the resection margin, skin incision, surgical approach can also be designed preoperatively. This feasible technique could increase the confidence for thoracic surgeons. Unnecessary explore time waste for locating small pulmonary nodules during the operation can be avoid, so the surgical accuracy can be improved, complications can be prevented, the duration of chest tube and length of hospital stay can be shortened.Keywords: Video-assisted thoracoscopic surgery (VATS); segmentectomy; three-dimensional reformation image Case No. 2: a 67-year-old male was admitted due to "lower extremity pain for more than one year". Chest CT: left upper lobe mass with the size of 3.0 cm × 3.5 cm, pulmonary function tests: FEV1 3.1 L (94%). He received VATS left upper lobe anterior segmentectomy. Operation hole: 4 cm incision in the left 4 th intercostal on the anterior axillary line; observation hole: 1.5 cm incision at the 7 th intercostal space on the left mid-axillary line. The operation took 5 hours, blood loss was 400 mL due to serious chest cavity adhesion. Postoperative complications were not observed, and he discharged on the 6 th day postoperatively.Pathology: bronchiolitis obliterans organizing pneumonia, BOOP ( Figure 3). Case No. 3: a 71-year-old female was admitted due to a ground glass opacity (GGO) was found after chest CT screening. The size of the GGO (1.5 cm × 1.2 cm) located in the superior segment of the left lower lobe (Figure 4 intercostal space on the left inferior angle line of scapula. Operation time took 2 hours, blood loss was 100 mL. There were no postoperative complications. She was discharged on the 7 th day postoperatively. Pathology: invasive adenocarcinoma, lepidic growth predominant (90%), T1bN0M0, stage IA2. No signs of recurrence or metastasis were found in 2 years' follow-up ( Figure 5). Case No. 4: a 73-year-old woman was admitted for founding a GGO during the screening test (1.0 cm × 1.0 cm) ( Figure 6). Her pulmonary function result was FEV1: 1.51 L (54.7% predicted). She was a non-smoker, with negative bronchoscopy findings. There were no positive past medical history and co-morbidities. The first 1.5 cm incision was selected in the eighth intercostal space in the midaxillary line, and was used for the camera (30 degree 10 mm high definition video thoracoscope). A 4-cm long incision was made in the fourth intercostal space in the preaxillary ...

Progress in three‐dimensional computed tomography reconstruction in anatomic pulmonary segmentectomy

“…Studies have indicated that the 3D images can be rotated freely and visualized interactively from any angle, which can directly measure the distance and positional relationship between the blood vessels, bronchus and the lesion, perform intraoperative navigation with the assistance of related software, 33 avoid the unnecessary dissection of lung tissue, and save intraoperative time to find and discern the segmental pulmonary venous vessels, thus shortening the operation time, 34 reducing the amount of bleeding during the operation, and improving the success rate of the operation. Three‐dimensional reconstruction is helpful for preoperative positioning, surgical planning, preoperative simulation and intraoperative navigation, and provides a reference for formulating an individualized surgical plan 35–37 …”

“…Three‐dimensional reconstruction is helpful for preoperative positioning, surgical planning, preoperative simulation and intraoperative navigation, and provides a reference for formulating an individualized surgical plan. 35 , 36 , 37 …”

Preoperative Three-Dimensional Lung Simulation Before Thoracoscopic Anatomical Segmentectomy for Lung Cancer: A Systematic Review and Meta-Analysis

“…The application of segmentectomy, which is associated with less trauma, fewer complications, and less pain for patients than thin-section and low-dose computed tomography, is more conducive for patients with non-small-cell lung cancer ( 3 ). 3D computed tomography of lung segments can ensure the position of the lung tumor within the anatomical segment and assist in the prediction of surgical margins ( 4 ). However, whether preoperative 3D lung simulation is better than non-3D procedures in segmentectomy for lung cancer remains controversial.…”