Utility of three-dimensional computed tomography in general thoracic surgery

Akiba, Tadashi

doi:10.1007/s11748-013-0336-z

Cited by 29 publications

(21 citation statements)

References 90 publications

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“…3-D CT simulation provides useful information for thoracoscopic surgery (15,16). We previously reported on port-access thoracoscopic anatomic lung segmentectomy and subsegmentectomy using 3-D CT simulation for small lung nodules (17,18).…”

Section: Technical Aspects Of Vats Subsegmentectomymentioning

confidence: 99%

Video-assisted thoracoscopic subsegmentectomy for small-sized pulmonary nodules

et al. 2017

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Segmentectomy has been widely performed as one of the types of limited resections that are performed for the resection of small-sized lung nodules. Video-assisted thoracoscopic surgery has also been in demand as a minimally invasive surgery. Subsegmentectomy is a much more limited resection than segmentectomy, but the technique is complex because it requires keen anatomical identification of small pulmonary structures. Therefore, there has been little reported about subsegmentectomy in medical literature. The recent development of computed tomography is remarkable, and some reports describe three-dimensional computed tomography as providing useful information because it assists surgeons in the performance of thoracoscopic anatomical subsegmentectomy. The creation of an intersubsegmental line is a key process in subsegmentectomy, therefore, some methods have been reported. We have safely and accurately performed some video-assisted thoracoscopic subsegmentectomies for small-sized lung tumors, using the three-dimensional computed tomography simulation and creating the intersubsegmental line with the inflation-deflation technique. In this article, we describe the recent techniques and roles of video-assisted thoracoscopic subsegmentectomy, and offer prospects for this procedure with our clinical data. more anatomically detailed resection that can involve the dissection of hilar lymph nodes attached to the segment containing the tumor. Moreover, the oncological outcomes of segmentectomy in a propensity-matched study were comparable to those of lobectomy for patients with earlystage non-small cell lung cancer (6). Segmentectomy has thus become widely used worldwide (1). While wedge resection has been applied to smaller lung nodules located in peripheral parenchyma, segmentectomy has been applied to small-sized lung nodules that show not only GGOs, but also solid appearances located in deep parenchyma. Recent developed CT enabled the detection of small-sized pulmonary nodules containing GGO component. For such smaller pulmonary nodules, especially located in the deep parenchyma, subsegmentectomy may be an alternative procedure; this is because it is difficult to perform a wedge resection for hilum nodules located in the deep parenchyma and segmentectomy may be an excessive resection for appropriate surgical margins.The role of subsegmentectomy is therefore considered as an intermediate procedure between wedge resection and segmentectomy. Consequently, we have concluded that the best indications for subsegmentectomy are as follows: (I) lung tumors of indeterminate nature, but considered suspicious for malignancy; (II) planned resection of a cT1aN0M0 primary lung cancer tumor less than 2 cm in diameter, with a GGO ratio of greater than 80% by highresolution CT, in patients with good pulmonary function who are able to tolerate lobectomy ( Figure 1A,B,C); (III) compromised resection in patients who are considered to be poor candidates for lobectomy due to limited cardiopulmonary reserve or other organ failure; (...

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Section: Technical Aspects Of Vats Subsegmentectomymentioning

confidence: 99%

Video-assisted thoracoscopic subsegmentectomy for small-sized pulmonary nodules

et al. 2017

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“…3D-CT imaging is a powerful tool for thoracic surgeons to determine pulmonary anatomy in a more intuitive manner when compared with conventional CT images. 3D-CT images help surgeons better understand the pulmonary anatomy of each patient before and during surgical procedures (17)(18)(19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

3D-CT anatomy for VATS segmentectomy

Shimizu¹,

Nakazawa²,

Nagashima³

et al. 2017

J. Vis. Surg.

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Segmentectomy has become a widely adopted surgical procedure, with recent reports describing the use of video-assisted thoracoscopic surgery (VATS) and robotic surgery. A major feature of segmentectomy is that it requires a three-dimensional (3D) understanding of the patient's pulmonary structure and a thorough preoperative analysis of the patient's individual anatomy. Here, we present our method for VATS segmentectomy based on 3D-computed tomography (3D-CT), with a review of the literature. We focus on techniques for 3D-CT reconstruction, analyses of the individual anatomy and anomalies, preoperative simulations of the procedure and surgical margin, and intraoperative navigation with 3D-CT images. We also reference the roles of members of our multi-disciplinary surgical team.

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“…A conventional enhanced computed tomography (CT) scan is the gold standard for imaging assessment. CT angiography (CTA) with three‐dimensional (3D) reconstruction imaging and even rapid prototyping is expected to facilitate anatomic study, simulation, and planning for thoracic surgery . High‐quality 3D‐CT imaging, which clearly reveals the anatomy of pulmonary vessels and bronchi, could play an important role in safe, efficient, minimally invasive pulmonary anatomical resection .…”

Section: Introductionmentioning

confidence: 99%

“…CT angiography (CTA) with three-dimensional (3D) reconstruction imaging and even rapid prototyping is expected to facilitate anatomic study, simulation, and planning for thoracic surgery. 3,4 High-quality 3D-CT imaging, which clearly reveals the anatomy of pulmonary vessels and bronchi, could play an important role in safe, efficient, minimally invasive pulmonary anatomical resection. 5 Thus, we introduced CTA with 3D reconstruction imaging and biopsy pathology to selected patients for better assessment and surgery planning.…”

Section: Introductionmentioning

confidence: 99%

Analysis of giant thoracic neoplasms: Correlations between imaging, pathology and surgical management

et al. 2017

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BackgroundA giant thoracic neoplasm is extremely rare and poorly understood. Our systemic study introduced computed tomography angiography (CTA) with three‐dimensional (3D) reconstruction imaging and evaluated correlations between imaging, pathology, and surgical management.MethodsData from 45 patients undergoing surgery for giant thoracic neoplasm in our institution between May 2007 and November 2015 were collected. The clinical characteristics, imaging manifestations, preoperative biopsy, surgical management, postoperative pathology, and prognosis and their correlation were analyzed.ResultsThe clinical characteristics, imaging manifestations, and pathological types were complicated. Four patients underwent CTA with 3D reconstruction imaging and feeding vessels were found in three cases. Twenty‐four selected patients accepted preoperative biopsy, eight of which were inconsistent with postoperative pathology. Complete resection was performed in 39 cases, 20 of which underwent extended excision. The median survival duration of all patients was 58 months (range 3.0–118.0). The one, three, and five‐year survival rates were 86.0%, 64.4%, and 47.0%, respectively. Univariate analyses showed tumor size and resection status were prognostic factors for survival (P = 0.003 and P < 0.001, respectively).ConclusionsA giant thoracic neoplasm should preferably be treated in experienced centers for precise diagnosis and optimal therapy schemes with comprehensive consideration of clinical characters, imaging manifestations, pathology, surgical management, and prognosis. Innovative CTA with 3D reconstruction imaging together with preoperative biopsy are feasible and effective in therapeutic decision‐making and surgical planning. Complete surgical resection remains the mainstay of curative therapy for all resectable tumors.

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Utility of three-dimensional computed tomography in general thoracic surgery

Cited by 29 publications

References 90 publications

Video-assisted thoracoscopic subsegmentectomy for small-sized pulmonary nodules

Video-assisted thoracoscopic subsegmentectomy for small-sized pulmonary nodules

3D-CT anatomy for VATS segmentectomy

Analysis of giant thoracic neoplasms: Correlations between imaging, pathology and surgical management

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