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. 2023 Nov 26;59(12):2079.
doi: 10.3390/medicina59122079.

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

Giorgio Cannone  1 , Vincenzo Verzeletti  1 , Alberto Busetto  1 , Luigi Lione  1 , Alessandro Bonis  1 , Samuele Nicotra  1 , Alessandro Rebusso  1 , Marco Mammana  1 , Marco Schiavon  1 , Andrea Dell'Amore  1 , Federico Rea  1
Affiliations

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

Giorgio Cannone et al. Medicina (Kaunas). .

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.

Keywords: VATS segmentectomy; lung cancer; three-dimensional reconstruction.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient #1: Example of 3D reconstruction of the broncho-vascular anatomy. The airways are shown in yellow, the arteries in red, and the veins in blue. The pulmonary lesion localized in the apico-posterior (S1 + 2) segment of the left upper lobe is depicted in orange, and the safety cuff for the resection margins in green.
Figure 2
Figure 2
Patient #3. Panel (A) highlights the lung parenchyma corresponding to the segments to be resected (7 + 8) along with the nodule and specific broncho-vascular elements. Panel (B) simulates the surgical field after parenchymal resection and selective ligation of broncho-vascular elements.
Figure 3
Figure 3
Patient #4: Venous drainage of the left upper pulmonary lobe seen after surgical dissection and isolation of anatomic elements (A) and directly from virtual 3D reconstruction (B).
See this image and copyright information in PMC

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