RESUMO
BACKGROUND: This study aimed to evaluate the effect of three-dimensional (3D) interactive quantitative surgical planning on the outcome of video-assisted thoracoscopic surgery (VATS) anatomical partial lobectomy (APL), and to investigate the learning curve of 3D reconstruction-assisted VATS APL assisted. METHODS: We retrospectively analyzed 156 cases of solitary pulmonary ground-glass opacity (GGO) lesions in patients who underwent 3D interactive quantitative VATS APL. Digital imaging and communications in medicine data were recorded for each patient. We used Materialise 3-Matic software to make 3D reconstructed images. All surgeries were performed by the same thoracic surgeon at the Cardiothoracic Surgery Department of Yichang Central People's Hospital between February 28, 2018, and April 20, 2020. The learning curve was evaluated using operative time and the cumulative sum (CUSUM) value of operative time in all cases. RESULTS: VATS APL was performed in every patient successfully, and there were no conversions to thoracotomy or lobectomy. The median surgical margin distance was 2.2 (range, 2.0-2.8) cm. All patients had an R0 complete cancer resection on histology. The histological subtypes of the segmental lesions included 69 cases of minimally invasive adenocarcinoma (MIA), 61 cases of adenocarcinoma, one case of squamous cell carcinoma, 16 cases of adenocarcinoma in situ (AIS), and nine cases of atypical adenomatous hyperplasia (AAH). The median operation time was 119 (range, 57-245) min, and median intraoperative blood loss was 37 (range, 15-247) mL. The median duration of thoracic drainage tube insertion was 2.3 (range, 1-23) days after surgery. The median length of postoperative hospital stay was 3.7 (range, 3-25) days. There were no cases of perioperative death. During the median postoperative follow-up period of 11 (range, 2-26) months, no tumor recurrence or postoperative death was observed. 3D interactive quantitative surgical planning facilitates safe and efficient VATS APL with a learning curve of 30 cases. CONCLUSIONS: 3D interactive quantitative surgical planning for VATS APL is a feasible option for inexperienced surgeons, with acceptable safety and complications.
RESUMO
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) sub-sub 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.