Three-dimensional reconstruction facilitates thoracoscopic anatomical partial lobectomy by an inexperienced surgeon: a single-institution retrospective review

Liu, Yun; Zhang, Songlin; Liu, Chaobing; Sun, Lailong

doi:10.21037/jtd-21-1578

Cited by 6 publications

(6 citation statements)

References 22 publications

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“…In our opinion, the systematic use of 3D-CT reconstructions, both in pre-operative and intraoperative settings, can reduce not only the likelihood of intraoperative complications related to interpretations of segmental anatomy but can also help to decrease operative time, because surgeons have already clearly "seen" the bronchovascular anatomy before surgery. We reported no intraoperative complications, and the surgical time of our preliminary tests were in line with literature results for segmentectomies performed with 3D reconstructions [21]. Nevertheless, we must remember that this paper reports only our preliminary findings, and improvements are ongoing.…”

Section: Discussionsupporting

confidence: 86%

“…With 3D images, aspiring surgeons may familiarize themselves with lung anatomy and could approach segmental structures and variations in an interactive way, simulating surgical procedures by cutting the bronchovascular structures in the same order as they would in real surgery. Moreover, there is already evidence that 3D images might improve surgical residency training [21].…”

Section: Discussionmentioning

confidence: 99%

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

Cannone,

Verzeletti,

Busetto

et al. 2023

Medicina

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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.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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

Cannone,

Verzeletti,

Busetto

et al. 2023

Medicina

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“…The high-quality 3D reconstructions rendered by modern CT-imaging techniques might also possess educational value in obtaining informed consent from patients regarding the surgical procedure they are subjected to. Also, evidence suggests it might improve surgical residency training ( 37 , 45 , 52 , 53 ). The latter was investigated by Zhang et al ( 46 ), who found evidence of faster learning of complex VATS procedures in surgical residents that used 3D reconstructions in their surgical preparation, compared to older surgeons that did not have these sophisticated techniques at their disposal, although age might have confounded these results.…”

Section: Resultsmentioning

confidence: 99%

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

Vervoorn

Wulfse²,

Hoesein³

et al. 2022

Front. Surg.

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BackgroundPulmonary surgery is an innovative discipline with increasing demands for minimally invasive techniques in complicated anatomical resections, warranting adequate preoperative imaging of relevant surgical anatomy to ensure safe and radical resection of target lesions. Over the recent years, the emergence of imaging techniques enabling three-dimensional reconstruction has exerted promising influence on pulmonary surgery, facilitating optimal surgical planning and easier identification of the spatial relationship between bronchovascular structures in the individual patient and aiding the safe resection of target pulmonary lesions. The goal of this mini-review is to provide an overview of three-dimensional computed tomography imaging within pulmonary surgery.MethodsThe authors performed a targeted qualitative review of the literature to identify current trends and to provide better understanding of three-dimensional reconstruction within the boundaries of pulmonary surgery.ResultsThree-dimensional reconstructive techniques can be used for resectability assessment, identification of surgically relevant interindividual anatomic variance and may improve perioperative outcomes.DiscussionThree-dimensional reconstruction using computed tomography imaging improves surgical planning and there is evidence that it results in shorter operative times, less intraoperative blood loss and lower rates of surgical conversion, as it can be applied both pre- and intraoperatively.

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“…Both in the simple and complex groups, the initial learning period showed a longer operative time, but intraoperative bleeding and postoperative complications were in a more acceptable range, which can be attributed to the correct preoperative 3D reconstruction and planning of the surgical procedure. Variations in vascular and bronchial structures may increase operative time and the risk of accidental bronchial injury, but with recent advances such as image processing and artificial intelligence 3D reconstruction allowing proof of the precise structure of the pulmonary arteries and veins, this allows surgeons to perform CSS more safely and effectively ( 21 – 23 ).…”

Section: Discussionmentioning

confidence: 99%

Learning curve analysis of single-port thoracoscopic combined subsegmental resections

et al. 2023

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BackgroundCombined subsegmental surgery (CSS) is considered to be a safe and effective resection modality for early-stage lung cancer. However, there is a lack of a clear definition of the technical difficulty classification of this surgical case, as well as a lack of reported analyzes of the learning curve of this technically demanding surgical approach.MethodsWe performed a retrospective study of single-port thoracoscopic CSS performed by the same surgeon between April 2016 and September 2019. The combined subsegmental resections were divided into simple and complex groups according to the difference in the number of arteries or bronchi which need to be dissected. The operative time, bleeding and complications were analyzed in both groups. Learning curves were obtained using the cumulative sum (CUSUM) method and divided into different phases to assess changes in the surgical characteristics of the entire case cohort at each phase.ResultsThe study included 149 cases, including 79 in the simple group and 70 in the complex group. The median operative time in the two groups was 179 min (IQR, 159-209) and 235 min (IQR, 219-247) p < 0.001, respectively. And the median postoperative drainage was 435 mL (IQR, 279-573) and 476 mL (IQR, 330-750), respectively, with significant differences in postoperative extubation time and postoperative length of stay. According to the CUSUM analysis, the learning curve for the simple group was divided by the inflection point into 3 phases: Phase I, learning phase (1st to 13th operation); Phase II, consolidation phase (14th to 27th operation), and Phase III, experience phase (28th to 79th operation), with differences in operative time, intraoperative bleeding, and length of hospital stay in each phase. The curve inflection points of the learning curve for the complex group were located in the 17th and 44th cases, with significant differences in operative time and postoperative drainage between the stages.ConclusionThe technical difficulties of the simple group of single-port thoracoscopic CSS could be overcome after 27 cases, while the technical ability of the complex group of CSS to ensure feasible perioperative outcomes was achieved after 44 operations.

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Three-dimensional reconstruction facilitates thoracoscopic anatomical partial lobectomy by an inexperienced surgeon: a single-institution retrospective review

Cited by 6 publications

References 22 publications

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

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

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

Learning curve analysis of single-port thoracoscopic combined subsegmental resections

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