Application of Three-dimensional Reconstruction in Anatomical Right Lateral Basal (RS9) Segmentectomy

Abstract

Objective This study analyzed the application of three-dimensional (3D) reconstruction in the vascular and bronchial branching patterns of right anterior, lateral, and posterior basal segments (RS8, RS9, and RS10) and anatomical RS9 segmentectomy. Methods From May 2020 to May 2022, 354 patients were selected for 3D reconstruction of vascular and bronchial branching patterns using Mimics 21.0. Based on the preoperative and intraoperative 3D reconstruction data, anatomical RS9 segmentectomy was conducted among 27 patients, and the surgical outcomes were retrospectively analyzed. Results The branching patterns of the right basal bronchi (B8, B9, and B10) were divided into the B8 and B9 + 10 type (74.6%), the B8 + 9 and B10 type (15.3%) and the B8 and B9 and B10 type (10.2%). The branching patterns of the right basal arteries (A8, A9 and A10) were classified into simple bifurcated type (the A8 and A9 + 10 type (62.4%) and the A8 + 9 and A10 type (13.0%)), split bifurcated type (the A8 and A8 + 9 + 10 type (18.4%) and the A8 + 9 and A9 + 10 type (3.7%)) and trifurcated type (the A8, A9 and A10 type (2.5%)). The branching patterns of the right basal veins (V8, V9, and V10) were complex and were classified into simple bifurcated, split bifurcated, and trifurcated types and further divided into ten subtypes. Of these types, the V8 + 9 and V10 type, the V8 + 9 + 10 and V10 type, and the V8 + 9 and V9 + 10 type were most common, accounting for 29.4%, 25.4% and 21.5% of cases, respectively. Anatomical RS9 segmentectomy was successfully completed without conversion to thoracotomy in all 27 patients. Conclusions 3D reconstruction is a practical tool for analyzing the bronchovascular branching patterns of RS8, RS9, and RS10. The application of 3D reconstruction is safe and feasible in anatomical RS9 segmentectomy.