Thoracoscopic Pulmonary Sub-Subsegmentectomy Based on Three-Dimensional Images

Wu, Weibing; Xu, Xinfeng; Wen, Wei; Xu, Jianping; Zhu, Quan; Liang, Changhong

doi:10.1016/j.athoracsur.2016.04.048

Cited by 32 publications

(18 citation statements)

References 5 publications

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“…Surgical simulation with 3D images also helps to plan the surgical approach. Through real‐time navigation during surgery actual anatomical structures correspond one‐to‐one to the virtual anatomical structures, which reduces the difficulty and improves the accuracy of the surgical technique . In this study, we successfully completed several CSSs under 3D‐CTBA guidance and the early clinical results were satisfactory.…”

Section: Discussionmentioning

confidence: 81%

Three‐dimensional navigation‐guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules

Xia

Pan

et al. 2018

Thoracic Cancer

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BackgroundExtended or combined segmentectomies are usually adapted for intersegmental pulmonary nodules. This study explored precise combined subsegmentectomy (CSS) under the guidance of three‐dimensional computed tomography bronchography and angiography (3D‐CTBA).MethodsThe definition of a pulmonary intersegmental nodule was based on a minimum distance between the nodule and the involved intersegmental veins in the preoperative 3D‐CTBA being less than the size of the nodule. Centering on the involved intersegmental vein, two adjacent subsegments belonging to the different segments were combined as a resected unit.ResultsWe retrospectively reviewed the records of 47 patients (mean age 53.6 ± 12.3, range: 26–81 years) who underwent CSS. Thirty‐nine (83.0%) nodules were involved in most intersegmental locations of the upper lobes; the remainder in the lower lobes. The mean nodule size was 0.86 ± 0.32 cm; the mean margin width was 2.20 ± 0.38 cm. Pathological stages included: Tis (8 cases), T1mi (16), IA1 (T1aN0M0, 13), and IA2 (T1bN0M0, 5). Pathological diagnoses included: invasive adenocarcinoma (18 cases), minimally invasive adenocarcinoma (16), adenocarcinoma in situ (8), atypical adenomatous hyperplasia (3), and benign (2). The average operative duration was 190.8 ± 54.9 minutes; operative hemorrhage was 42.7 ± 23.0 mL; 5.8 ± 2.8 lymph nodes dissected had not metastasized; the duration of postoperative chest tube drainage was 3.0 ± 1.8 days; and the postoperative hospital stay was 5.3 ± 2.4 days.ConclusionsUnder 3D navigation, thoracoscopic CSS is a safe technique for intersegmental nodules, sparing more pulmonary parenchyma and ensuring safe margins to achieve anatomical resection.

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Section: Discussionmentioning

confidence: 81%

Three‐dimensional navigation‐guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules

Xia

Pan

et al. 2018

Thoracic Cancer

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“…The key to the implementation of this operation is to accurately grasp the anatomical structure of the target segment. The 3D-CTBA can provide a precise anatomical structure, identify the intrasegmental and intersegmental veins from different views [8]. Some complicated pulmonary segmentectomy should be performed under the guidance of 3D-CTBA [9,10].…”

Section: Resultsmentioning

confidence: 99%

VATS right upper posterior segmentectomy with anomalous bronchiand pulmonary vessels: a case report and literature review

Zhang

Zhu

et al. 2020

Preprint

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BackgroundAnatomic variation may increase the difficulty and risk for anatomic segmentectomy. The preoperative three-dimensional computed tomography bronchography and angiography(3D-CTBA) can provide a detailed model of the segmental structure, and contribute to precise and safe segmentectomy.Case presentationWe report a case with anomalous bronchi and pulmonary vessels in the right upper posterior segment (RS2), under the guidance of 3D-CTBA, anatomic RS2segmentoctomywas performed accurately and safely, the postoperative condition was uneventful.ConclusionsThis rare case highlights the importance of 3D-CTBA to guild accurate segmentectomy with anatomic variation.

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“…As mentioned earlier, preoperative 3D-CTBA has been widely used in segmentectomy [ 10 , 16 – 19 ]. Preoperative simulation on the 3D image is helpful for surgical planning, which includes identification of the target vessels, bronchus, and surgical margin, as well as any anatomic variations and the relationship between the nodule and the reconstructed vessels and bronchus [ 14 , 16 ]. However, the above methods are not able to completely solve the problem of location of the nodules.…”

Section: Discussionmentioning

confidence: 99%

Preoperative non-invasive visual localization of synchronous multiple lung cancers using three-dimensional computed tomography lung reconstruction

Zhang

et al. 2021

J Cardiothorac Surg

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Background Synchronous multiple primary lung cancers are becoming more common with increasing use of computed tomography for screening. Intraoperative localization and resection of ill-defined pulmonary ground-glass opacities during thoracoscopic resection is challenging. This study aimed to determine the clinical feasibility of non-invasive visual localization of these nodules by three-dimensional computed tomography lung reconstruction before sublobar resection. Methods Forty-four patients with synchronous multiple primary lung cancers underwent thoracoscopic pulmonary resection at our institution between June 2017 and August 2019. Preadmission computed tomography images were downloaded and reconstructed into a three-dimensional model. Small nodules (< 15 mm) were localized non-invasively by three-dimensional computed tomography lung reconstruction before surgery. Patient demographics, nodule characteristics, procedural details, pathological data, and outcomes were obtained from the medical records. Results One hundred and twenty-one pulmonary nodules from the 44 patients were scheduled for video-assisted thoracic surgery; 54 (44.6%) were pure ground-glass opacities and 57 (47.1%) were mixed ground-glass opacities. One hundred and seventeen nodules were localized preoperatively. The mean nodule diameter was 7.67 ± 3.87 mm. The mean distance from the nodule to the pleura was 14.84 ± 14.43 mm. All nodules were removed successfully by wedge resection (27 patients), lobectomy (26 patients), or segmentectomy (25 patients). Most lesions (85.1%) were malignant. Paraffin pathology revealed 12 cases of atypical adenomatous hyperplasia (9.92%), 13 of adenocarcinoma in situ (10.74%), 16 of minimally invasive adenocarcinoma (13.22%), and 73 of invasive adenocarcinoma (60.33%). Conclusions Three-dimensional computed tomography lung reconstruction is a feasible and alternative method of visual localization for small lung nodules before sublobar resection in some suitable patients.

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Thoracoscopic Pulmonary Sub-Subsegmentectomy Based on Three-Dimensional Images

Cited by 32 publications

References 5 publications

Three‐dimensional navigation‐guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules

Three‐dimensional navigation‐guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules

VATS right upper posterior segmentectomy with anomalous bronchiand pulmonary vessels: a case report and literature review

Preoperative non-invasive visual localization of synchronous multiple lung cancers using three-dimensional computed tomography lung reconstruction

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