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 robot-assisted 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.

Keywords: Robotic surgery; ground-glass nodules; lung cancer; segmentectomy; three-dimensional computed tomography (3D CT) reconstruction.

Figure 1

Visualization of 3D reconstruction on a smartphone (10). Each anatomical structure (arteries, bronchi, lung segments, etc.) can be hidden and displayed back again. 3D, three-dimensional. Available online: http://asvidett.amegroups.com/article/view/22647

Figure 2

Pre and intraoperative use of 3D reconstruction (11). Clips showing visualization of 3D reconstruction on a tablet, placed next to the patient, before surgery to help chose port placement; and while performing robotic surgery, by displaying the 3D model below the surgical video feed. 3D, three-dimensional. Available online: http://asvidett.amegroups.com/article/view/22650

Figure 3

3D reconstruction example. (A,B) 3D reconstruction of a patient’s CT with a subpleural tumor (in green) located in the S1+2 segment; (B) same patient, but with S1+2, S3 and S4 contours hidden; (C,D) right lung of another patient; (D) S2 and S8 are hidden, showing the tumor in S2. 3D, three-dimensional.

Figure 4

Upper right lobe tumor. (A) Frontal view of the 3D reconstruction; (B) 3D reconstruction in lateral decubitus (operative positioning). Of note, sublobar segmentation is not shown because it was not ordered; (C) zoom, with superior and middle lobe hidden. All layers (arteries, veins, bronchi, etc.) can be shown or hidden; (D) the pulmonary veins are hidden and the 3D model is oriented like the surgical camera. 3D, three-dimensional.

Figure 5

Chest wall can be evaluated before surgery for optimal port placement. (A) Costal deformity can interfere with port placement. Clear view on 3D reconstruction; (B,C) the bones are clearly visible, so the relation between the tumor and the chest wall is well evaluated for port placement. 3D, three-dimensional.