Application of three-dimensional (3D) reconstruction in the treatment of video-assisted thoracoscopic complex segmentectomy of the lower lung lobe: A retrospective study

Abstract

BackgroundAn increasing number of lung ground-glass nodules (GGNs) have been detected ever since low-dose computer tomography started growing in popularity. Three-dimensional (3D) reconstruction technology plays a critical role in lung resection, especially in segmentectomy. In this study, we explore the role of 3D reconstruction in thoracoscopic complex segmentectomy of lower lung lobe.MethodsA total of 97 patients who underwent complex segmentectomy of lower lung lobe from January 2021 to March 2022 were retrospectively analyzed. We divided these patients into a 3D group (n = 42) and a routine group (n = 55) based on preoperative 3D reconstruction or without this procedure. The demographics of patients and GGNs were collected and perioperative outcomes were compared between the two groups.ResultsAll of the baseline characteristics between the groups were comparable (all P > 0.05). There was no 30-day postoperative mortality and conversion in the two groups. The operation time of the 3D group was significantly shorter than that of the routine group (111.4 ± 20.8 min vs. 127.1 ± 32.3 min, P = 0.007). The number of stapler reloads during surgery in the 3D group was less than that in the routine group (9.0 ± 2.2 vs. 10.4 ± 2.6, P = 0.009). The rate of air leakage on postoperative days 1–3 was lower in the 3D group (11.9% vs. 30.9%, P = 0.027). In addition, the resection margins of all patients in the 3D group were adequate, while four patients in the routine group had inadequate resection margins, although there was no statistically significant difference (P = 0.131). Intraoperative blood loss, postoperative drainage, postoperative hospital stay, pneumonia/atelectasis, and hemoptysis were similar between the two groups.ConclusionsFor performing complex segmentectomy of the lower lung lobe, the procedure of 3D reconstruction may shorten the operation time, decrease the number of stapler reloads, prevent postoperative air leakage, and guarantee a safe surgical margin. Therefore, 3D reconstruction is recommended for complex segmentectomy of the lower lung lobe.

Application of three-dimensional computed tomography imaging and reconstructive techniques in lung surgery: A mini-review

“…Results from multiple, primarily retrospective, comparative studies in patients operated on for a variety of pulmonary diseases, confirm this hypothesis, although the quality of evidence is debatable due to their retrospective nature ( Table 1 ). In these studies, 3D-imaging is associated with shorter operating times ( 22 , 36 , 37 , 44 – 46 ), more extensive mediastinal lymph node dissection ( 23 , 36 ), a reduction in stapler reloads ( 44 ), reduced air loss on postoperative days 1–3 ( 44 ) and decreased intraoperative blood loss ( 36 ). No significant difference in other surgery-related parameters was found, such as length of hospital-stay, overall recovery, incidence of other postoperative complications and residual pulmonary function ( 22 , 23 , 36 , 44 , 45 ).…”

“…In these studies, 3D-imaging is associated with shorter operating times ( 22 , 36 , 37 , 44 – 46 ), more extensive mediastinal lymph node dissection ( 23 , 36 ), a reduction in stapler reloads ( 44 ), reduced air loss on postoperative days 1–3 ( 44 ) and decreased intraoperative blood loss ( 36 ). No significant difference in other surgery-related parameters was found, such as length of hospital-stay, overall recovery, incidence of other postoperative complications and residual pulmonary function ( 22 , 23 , 36 , 44 , 45 ). Furthermore, there is evidence from multiple studies that preoperative 3D-imaging aided in selection of the appropriate surgical entry site tailored to the individual patient by taking their specific anatomy into account, resulting in less perioperative switching in surgical approach and lower conversion rates ( 36 , 47 , 48 ).…”

What’s new in minimally invasive thoracic surgery? Clinical application of augmented reality and learning opportunities in surgical simulation

“…Arjomandi Rad et al described the role of augmented reality in reducing preoperative planning time and workload, helping surgeons to perform complex procedures more safely by facilitating the understanding of patient-specific anatomy and anatomical variations (24). The use of a 3D reconstruction can provide a safer intervention, in terms of less intraoperative complications (e.g., vascular or parenchymal tear or inappropriate resection), reduced operative time and improved carcinologic margins (25). Creation of 3D printable models and virtual 3D reconstructions may also be used, not only as a teaching support for medical students and young residents, but also for the patient, to clarify surgery and the extent of the procedure.…”

Harnessing 3D-CT Simulation and Planning for Enhanced Precision Surgery: A Review of Applications and Advancements in Lung Cancer Treatment

“…Kanzaki et al performed multisubsegmentectomies, such as right S 2 b + S 3 a, left S 1+2 a + b, or others, using VATS in 11 patients using a virtual 3D pulmonary model with CTTRY, a custom software they developed, and reported that all the patients had negative surgical margins [35]. Wang et al compared 92 cases of VATS complex segmentectomy divided into 42 cases in the 3D group and 55 in the routine group and reported that all the cases in the 3D group, in which preoperative 3D-CT reconstruction was performed, had adequate surgical margin of >2 cm [36]. Iwano et al defined the virtual safety margin as a sphere extending 2 cm outside the tumor in preoperative 3D-CT simulation and reported that no positive surgical margin was achieved in all 17 primary lung cancers in 16 patients after segmentectomy [37].…”

“…The use of preoperative 3D simulation led to better outcomes in many matters, including less intraoperative bleeding and chest tube duration [25], shorter operation time [26], fewer stapler reloads, and the reduction of postoperative air leakage on postoperative days 1-3 [36] compared to the cases without 3D simulation.…”