A simplified model for determining the cutting plane during thoracoscopic anatomical partial lobectomy of the right lower lobe

Abstract

Background: Few studies have examined the use of two-dimensional computed tomography (2D CT) and three-dimensional (3D) reconstruction images to determine the intersegmental plane (ISP) for pulmonary segmentectomy, but a systematic approach and nomenclature are currently lacking. This current study used 3D reconstruction of CT imaging to analyze variations in the right lower lobe's pulmonary ISP and created a simplified model to determine the optimum cutting plane (CP) for clinical application for operative planning and use during thoracoscopic anatomical partial lobectomy (APL). Methods: Between January 2018 and October 2019, 325 patients with pulmonary lesions were identified who underwent thin-slice CT scans of the chest. The ISPs were identified by analyzing the 2D CT scans and 3D reconstruction images and the anatomical characteristics segmental boundary. The CP for the thoracoscopic procedure was then determined within the safe surgical margins, and a simplified CP model was created. Results: The boundary between adjacent lung segment A and segment B was be expressed as "ISP: Sa-Sb". The ISP was divided into venous ISP (VISP), arterial ISP (AISP), and bronchial ISP (BISP). The proposed model of the CP can be expressed as follows: CP (f) = (V/A/B) ISP (x) + (V/A/B) sub ISP (y) + (V/A/B) subsub ISP (z).Conclusions: This report is a first attempt to provide a nomenclature for identifying the ISP, and create a simplified model for determining the CP for thoracoscopic partial lobectomy.

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

“…To date, many surgeons use traditional 2D CT imaging to estimate the resectability of a lesion and decide on operative approach. However, 3D-imaging using CT-based simulation techniques, sometimes assisted by artificial intelligence ( 14 ), can be used to accurately identify individual segments by tracing bronchovascular anatomy ( 15 , 16 ), making it possible to estimate the probability that a cancerous lesion in a single segment has safe anatomical margins for segmentectomy, or needs change of the original surgical plan to another resection (for instance: bi-segmentectomy, lobectomy) if surgical margins are deemed insufficient ( 17 – 21 ). Comparative studies support this by describing a lower percentage of inadequate resection margins when preoperative assessment was conducted using 3D reconstruction instead of conventional 2D-imaging ( 22 , 23 ).…”

Noninvasive 3D-CT simulation versus glue injection to localize small pulmonary nodules prior to anatomical segmentectomy: a randomized controlled trial

“…Moreover, the 3D-CTBA could be utilized to determine the intersegmental cutting plane during segmentectomy [ 12 ]. To date, the methods for identifying the intersegmental plane during segmentectomy include inflation–deflation technique, selective resected segmental inflation, indocyanine green, endobronchial dye, 3D-CTBA and virtual-assisted lung mapping [ 13 ].…”

Lung segments from anatomy to surgery

“…Liu et al [24] distinguished three types of subsuperior segmental bronchus according to the direction. The first is a posterior bronchus between B6 and B10 (known as the narrow sense of a subsuperior segmental bronchus), observed in 10.5% of patients.…”

“…If there is a B*, how is it connected to the segment? An additional segment called the subsuperior segment (S*) can be distinguished between S6 and S8-S10, coexisting with the accessory bronchus and having its own vascularization [24,63]. There is very little literature about S*.…”