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Cannone G, Verzeletti V, Busetto A, Lione L, Bonis A, Nicotra S, Rebusso A, Mammana M, Schiavon M, Dell’Amore A, Rea F. Three-Dimensional Imaging-Guided Lung Anatomic Segmentectomy: A Single-Center Preliminary Experiment. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2079. [PMID: 38138182 PMCID: PMC10744496 DOI: 10.3390/medicina59122079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/10/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023]
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.
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Affiliation(s)
- Giorgio Cannone
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (V.V.); (A.B.); (L.L.); (A.B.); (S.N.); (A.R.); (M.M.); (M.S.); (A.D.); (F.R.)
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Nakazawa S, Nagashima T, Kawatani N, Gedeon PC, DeSimone AK, Igai H, Kosaka T, Shirabe K. Anatomy of the lung revisited by 3D-CT imaging. VIDEO-ASSISTED THORACIC SURGERY 2023; 8:17. [PMID: 37711275 PMCID: PMC10501054 DOI: 10.21037/vats-23-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
The anatomy of the lung was originally described based on data acquired from cadaveric studies and surgical findings. Over time, computed tomography (CT) and three-dimensional (3D) imaging techniques have been developed, allowing for reconstruction and understanding of lung anatomy in a more intuitive way. The wide adoption of 3D-CT imaging technology has led to a variety of anatomical studies performed not only by anatomists but also by surgeons and radiologists. Such studies have led to new or modified classification systems, shed light on lung anatomy from a useful surgical viewpoint, and enabled us to analyze lung anatomy with a focus on particular anatomical features. 3D images also allow for enhanced pre- and intra-operative simulation, improved surgical safety, enhanced educational utility, and the capacity to perform large-scale anatomical studies in shorter time frames. We will review here the key features of 3D-CT imaging of the lung, along with representative anatomical studies regarding (I) general lung anatomy, (II) anatomy of the right and left lobes, and (III) features of interlobar vessels. The current surge of 3D imaging analysis shows that the field is growing, with the technology continuing to improve. Future studies using these new and innovative methodologies will continue to refine our understanding of lung anatomy while enhancing our ability to perform safe and effective surgical resections.
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Affiliation(s)
- Seshiru Nakazawa
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Toshiteru Nagashima
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Natsuko Kawatani
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Patrick C. Gedeon
- Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Ariadne K. DeSimone
- Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Takayuki Kosaka
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
- Department of Thoracic Surgery, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
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Hong Z, Lu Y, Sheng Y, Cui B, Bai X, Cheng T, Wu X, Jin D, Gou Y. Comparison of three-dimensional reconstruction and CT-guided Hook-wire segmental resection for pulmonary nodules: a propensity score matching study. World J Surg Oncol 2023; 21:161. [PMID: 37237377 DOI: 10.1186/s12957-023-03035-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE To analyze and compare the clinical application value of three-dimensional reconstruction and computed tomography (CT)-guided Hook-wire localization for row lung segment resection of pulmonary nodules. METHODS Retrospective analysis of the clinical data of 204 patients suffering from pulmonary nodules admitted to the Department of Thoracic Surgery of Gansu Provincial People's Hospital from June 2016 to December 2022. According to the preoperative positioning method, the group was divided into a 3D reconstruction group (98 cases) and a Hook-wire group (106 cases), respectively. The two groups of patients were propensity score matching (PSM) to compare their perioperative outcomes. RESULTS All patients in both groups underwent successful surgeries without perioperative deaths. After PSM, 79 patients were successfully matched in each group. Two cases of pneumothorax, three cases of hemothorax, and four cases of decoupling occurred in the Hook-wire group; no complications of pneumothorax, hemothorax, and decoupling occurred in the 3D reconstruction group. Compared to the Hook-wire group, the 3D reconstruction group has shorter operative time (P = 0.001), less intraoperative bleeding (P < 0.001), less total postoperative chest drainage (P = 0.003), shorter postoperative tube placement time (P = 0.001), shorter postoperative hospital stay (P = 0.026), and postoperative complications (P = 0.035). There was no statistically significant difference between the two groups in terms of pathological type, TNM staging, and number of lymph node dissection. CONCLUSION Three-dimensional reconstruction and localization of pulmonary nodules enables safe and effective individualized thoracoscopic anatomical lung segment resection with a low complication rate, which has good clinical application value.
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Affiliation(s)
- Ziqiang Hong
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Yingjie Lu
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yannan Sheng
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
| | - Baiqiang Cui
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Xiangdou Bai
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Tao Cheng
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Xusheng Wu
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Dacheng Jin
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Yunjiu Gou
- Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China.
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Ma X, Lu T, Qin D, Cai H, Tang Z, Yang Y, Cui Y, Wang R. Analysis of pulmonary artery variation based on 3D reconstruction of CT angiography. Front Physiol 2023; 14:1156513. [PMID: 37234424 PMCID: PMC10206427 DOI: 10.3389/fphys.2023.1156513] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/12/2023] [Indexed: 05/28/2023] Open
Abstract
Objective: The aim of this study is to acquire pulmonary CT (Computed tomography) angiographic data for the purpose of creating a three-dimensional reconstruction. Additionally, we aim to analyze the features and deviations of the branches in both pulmonary lobes. This information is intended to serve as a more comprehensive and detailed reference for medical professionals when conducting preoperative evaluations and devising surgical plans. Method: Between August 2019 and December 2021, 420 patients were selected from the thoracic surgery department at the First Hospital of Jilin University, and underwent pulmonary 64 channel contrast enhanced CT examinations (Philips ICT 256). The images were acquired at a 1.5 mm slice thickness, and the DCM files that complied with DICOM (Digital Imaging and Communications in Medicine) standards were analysed for 3D (three dimensional) reconstruction using Mimics 22.0 software. The reconstructed pulmonary artery models were assessed by attending chest surgeons and radiologists with over 10 years of clinical experience. The two-dimensional image planes, as well as the coronary and sagittal planes, were utilized to evaluate the arteries. The study analyzed the characteristics and variations of the branches and courses of pulmonary arteries in each lobe of the lungs, with the exception of the subsegmental arterial system. Two chest surgeons and two radiologists with professional titles-all of whom had over a decade of clinical experience-jointly evaluated the 3D models of the pulmonary artery and similarly assessed the characteristics and variations of the branches and courses in each lobe of the lungs. Results: Significant variations were observed in the left superior pulmonary artery across the 420 subjects studied. In the left upper lobe, the blood supply of 4 arteries accounted for 50.5% (n = 212), while the blood supply of 2 arteries in the left lower lobe was the most common, accounting for 79.5% (n = 334). The greatest variation in the right pulmonary artery was observed in the branch supply of the right upper lobe mediastinal artery. In the majority of cases (77.9%), there were two arteries present, which was the most common configuration observed accounting for 64% (n = 269). In the right inferior lobe of the lung, there were typically 2-4 arteries, with 2 arteries being the most common configuration (observed in 79% of cases, n = 332). Conclusion: The three-dimensional reconstruction of pulmonary artery CT angiography enables clear observation of the branches and distribution of the pulmonary artery while also highlighting any variations. This technique holds significant clinical value for preoperative assessments regarding lesions and blood vessels.
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Affiliation(s)
- Xiaochao Ma
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Tianyu Lu
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Da Qin
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Hongfei Cai
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ze Tang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yue Yang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Youbin Cui
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Rui Wang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
- School of Public Health, Jilin University, Changchun, Jilin, China
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Deng Y, Cai S, Huang C, Liu W, Du L, Wang C, Jia R, Lin S, Yu X, Yu X, Yang Y, Yang C, Zhao H, Wang Z, Wang L, Ma K, Yu Z, Guo X. Anatomical variation analysis of left upper pulmonary blood vessels and bronchi based on three-dimensional reconstruction of chest CT. Front Oncol 2022; 12:1028467. [PMID: 36479066 PMCID: PMC9720281 DOI: 10.3389/fonc.2022.1028467] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/07/2022] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND With its growing popularity and potential outcome, preoperative three-dimensional reconstruction of chest computed tomography (CT) has been widely used in video-assisted thoracic surgery (VATS) segmentectomy for treating non-small cell lung cancer (NSCLC). This study aimed to summarize the experience of anatomical variation analysis of left upper pulmonary blood vessels and bronchi based on the three-dimensional reconstruction of chest CT. MATERIALS AND METHODS A total of 103 patients with early-stage NSCLC were chosen to undergo VATS segmentectomy based on preoperative three-dimensional reconstruction of chest CT in our institute from September 2019 to July 2022. Data such as clinical characteristics and variations in blood vessels and bronchi were reviewed in this study. RESULTS The branches of the left lingular pulmonary artery may mutate into the LS1 + 2 + 3. A1 + 2 has four subtypes. The distribution of variation is relatively balanced, and the most common variation is type I (35/103, 33.9%). Most lingular arteries originate from the oblique cleft side of the lingular bronchus (79/103,76.7%). Most V(1 + 2)c* are small developments (70/103, 68.0%). The venous return of the proper segment mainly depends on V(1 + 2)b + c. The variation in the left upper lobe bronchus is complex. The most common variant is the bifurcation type (type A to G, 92/103, 89.3%) and bifurcation type A (62/103, 60.2%). The posterior apical segment artery of the left upper lobe is not accompanied by its bronchus. CONCLUSIONS The variation types of blood vessels and bronchus in the upper lobe of the left lung are complex. Preoperative CT-based three-dimensional reconstruction of pulmonary arteries, veins, and bronchi is of great significance. It can help understand the variations, accurately locate lesions before the surgery, and effectively plan surgeries.
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Affiliation(s)
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- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Xiaotong Guo
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
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