Three-Dimensional Imaging-Guided Lung Anatomic Segmentectomy: A Single-Center Preliminary Experiment

Abstract

Background and objectives: VATS segmentectomy has been proven to be effective in the treatment of stage I NSCLC, but its technical complexity remains one of the most challenging aspects for thoracic surgeons. Furthermore, 3D-CT reconstruction images can help in planning and performing surgical procedures. In this paper, we present our personal experience of 11 VATS anatomical resections performed after accurate pre-operative planning with 3D reconstructions. Materials and methods: A 3D virtual model of the lungs, airways, and vasculature was obtained, starting from a 1.25 mm 3-phase contrast CT scan, and the original images were used for the semi-automatic segmentation of the lung parenchyma, airways, and tumor. Results: Six males and five females were included in this study. The median diameter of the pulmonary lesion at the pre-operative chest CT scan was 20 mm. The surgical indication was confirmed in seven patients: in three cases, a lobectomy, instead of a segmentectomy, was needed due to intraoperative findings of nodal metastasis. Meanwhile, only in one case, we performed a lobectomy because of inadequate surgical resection margins. Skin-to-skin operative average time was 142 (IQR 1-3 105–182.5) min. The median post-operative stay was 6 (IQR 1-3 3.5–7) days. The mean value of the closest surgical margin was 13.7 mm. Conclusion: Image-guided reconstructions are a useful tool for surgeons to perform complex resections in order to spare healthy parenchyma and to ensure disease-free margins. Nevertheless, human skill and surgeon experience still remain fundamental for the final decisions regarding the proper resection to perform.

Evolution of Three-Dimensional Computed Tomography Imaging in Thoracic Surgery

“…A wide variety of 3D CT software has recently been developed worldwide, such as Synapse Vincent (Fujifilm Medical Co., Tokyo, Japan), Ziostation 2 and REVORAS (Ziosoft, Inc., Tokyo, Japan), Materialise Mimics Innovation Suite 23 (Materialise NV, Leuven, Belgium), Deepinsight platform (Neusoft Group Ltd., Shenyang, China), and IQQA-Lung (EDDA Technology, Princeton, NJ, USA) [ 11 , 12 , 28 , 43 , 44 , 45 , 46 ]. Hagiwara et al reported that 97.8% of the 316 branches of the pulmonary artery, where 3D images were constructed using Synapse Vincent, were consistent with intraoperative findings [ 11 ].…”

“…Nakao et al also reported that the 3D CT images reconstructed by REVORAS were in almost complete agreement with the intraoperative findings in 18 of 20 cases [ 12 ]. Cannone et al presented their experience of 11 VATS anatomical resections performed after accurate preoperative planning with 3D reconstructions using a commercially available software, Materialise Mimics Innovation Suite 23 [ 43 ]. Moal et al also reported 3D CT reconstruction for operative planning in nine cases of RATS segmentectomy using highly specialized software (Visible Patient, Strasbourg, France) [ 44 ].…”