Three-dimensional computed tomography reconstruction for operative planning in robotic segmentectomy: a pilot study

Abstract

Background: The objective of our pilot study was to assess if three-dimensional (3D) reconstruction performed by Visible Patient™ could be helpful for the operative planning, efficiency and safety of robotassisted segmentectomy. Methods: Between 2014 and 2015, 3D reconstructions were provided by the Visible Patient™ online service and used for the operative planning of robotic segmentectomy. To obtain 3D reconstruction, the surgeon uploaded the anonymized computed tomography (CT) image of the patient to the secured Visible Patient™ server and then downloaded the model after completion. Results: Nine segmentectomies were performed between 2014 and 2015 using a pre-operative 3D model. All 3D reconstructions met our expectations: anatomical accuracy (bronchi, arteries, veins, tumor, and the thoracic wall with intercostal spaces), accurate delimitation of each segment in the lobe of interest, margin resection, free space rotation, portability (smartphone, tablet) and time saving technique. Conclusions: We have shown that operative planning by 3D CT using Visible Patient™ reconstruction is useful in our practice of robot-assisted segmentectomy. The main disadvantage is the high cost. Its impact on reducing complications and improving surgical efficiency is the object of an ongoing study. (5), from port placement (6) to anatomical resection (7,8). KeywordsAlthough 3D reconstruction can be achieved with software such as Advantage Workstation Volume Share (GE Healthcare™, Milwaukee, WI, USA) (9) or Synapse Vincent (Fujifilm™ Co., Tokyo, Japan) (5,8), this is time consuming and relies heavily on medical resources. Thus, we chose to outsource to Visible Patient™ (Strasbourg, France), a company specialized in this area.To be usable in daily practice, we considered that several requirements should be respected, as shown in Table 1.The objective of our pilot study was to assess if 3D reconstruction performed by Visible Patient™ could meet all these criteria and could be helpful for the operative planning, efficiency, and safety of mini-invasive thoracic surgery. MethodsThe present study was approved by the Review Board of our institution (No. E2017-31) and written consent was obtained from each patient to send the anonymized data from their CT to Visible Patient. Inclusion and exclusion criteriaInclusion criteria: patients with a progressing ground glass nodule ≤2 cm, compromised patients with stage I or II solid tumors, patients with small sized solid tumors with no histological documentation (negative CT-guided and fibroscopic biopsy), defined as not resectable by wedge resection by the treating surgeon.Exclusion criteria: patients with lesions extending beyond a single lung segment, rapidly progressive or profuse metastatic diseases, and patients unfit for general anaesthesia. Pre-operative assessmentEach patient was assessed by CT (thorax, abdomen, and brain), PET-CT, respiratory function evaluation, cardiologic assessment (ECG and sometimes echocardiography), and bronchoscopy. Image acquisition and 3D reconstructionAll...

Virtual reality and artificial intelligence for 3-dimensional planning of lung segmentectomies

“…11,12 Furthermore, in currently available techniques 3D segmentation (which is the identification and selective coloring of an anatomic structure) is often performed manually (by technicians), which increases the risk for error, requires manual labor, is time-consuming, and for this reason is more expensive. 18 Another shortcoming of the available 3D modeling software is that it commonly requires contrast-enhanced CT scanning for accurate segmentation, which results in radiation and iodinecontrast agent exposure and consequently in additional health risks for patients. 18 In this study, we have demonstrated that our PulmoVR application provides a unique environment to review patient-specific segmental anatomy by facilitating selective AI-based automatic labeling, visualization, and assessment of pulmonary structures, without the need for contrast-enhanced CT imaging.…”

Development of a precision multimodal surgical navigation system for lung robotic segmentectomy

“…The clinical value of the 3D model was validated in 2014 in a pilot study (6). Progressively, we have reached the conclusion that the availability of such Figure 1 Flow chart of the implementation of our robotic technique of segmentectomy reinforced by our multimodal imaging system (5-7).…”

“…3D reconstruction (Visible Patient TM ) for preoperative planning Pilot Study (6) 2013-2015 3D reconstruction for pre-operative planning and intraoperative real-time imaging 2016-2017 3D reconstruction and Pleural dye marking for certain tumor location (7) 2016-2017…”

“…We also use the same system for video-assisted thoracic surgery (VATS) procedures (Figures 4-7). Continuing the integration of the 3D model to a higher level is done by displaying it in the direct field of view of the operating surgeon at the level of the robotic console, through a simple HDMI connection from a portable device (6). The surgeon maintains the option of exploring all the functions of the model.…”

Robotic pulmonary segmentectomy

“…Pre-operative CT chest with 3D reconstruction can be extremely helpful to become familiar with the segmental anatomy and identify the branches of the vein, pulmonary artery, and bronchus to the particular segment. This also allows the surgeon to decide if segmentectomy would be an adequate oncological resection (31,32). Pre-operative localization of the smaller deeper nodule can be helpful for intra-operative identification of the lesion.…”