Binocular stereo-navigation for three-dimensional thoracoscopic lung resection

BMC Surgery

Takamasa Onuki¹  Masahide Murasugi¹  Kunihiro Oyama¹  Shota Mitsuboshi¹  Takehito Yoshiya¹  Kei Sakamoto¹  Takuma Kikkawa¹  Tamami Isaka¹  Masato Kanzaki¹ 

[1] Department of Surgery I, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan

关键词: Binocular stereo-navigation;    Three-dimensional imaging;    Thoracoscopic sublobar resection;    Video-assisted thoracic surgery;    Computed tomography;   

Others  :  1204300
DOI  :  10.1186/s12893-015-0044-y

 received in 2014-09-16, accepted in 2015-04-30,  发布年份 2015

【 摘 要 】

Background

This study investigated the efficacy of binocular stereo-navigation during three-dimensional (3-D) thoracoscopic sublobar resection (TSLR).

Methods

From July 2001, the authors’ department began to use a virtual 3-D pulmonary model on a personal computer (PC) for preoperative simulation before thoracoscopic lung resection and for intraoperative navigation during operation. From 120 of 1-mm thin-sliced high-resolution computed tomography (HRCT)-scan images of tumor and hilum, homemade software CTTRY allowed sugeons to mark pulmonary arteries, veins, bronchi, and tumor on the HRCT images manually. The location and thickness of pulmonary vessels and bronchi were rendered as diverse size cylinders. With the resulting numerical data, a 3-D image was reconstructed by Metasequoia shareware. Subsequently, the data of reconstructed 3-D images were converted to Autodesk data, which appeared on a stereoscopic-vision display. Surgeons wearing 3-D polarized glasses performed 3-D TSLR.

Results

The patients consisted of 5 men and 5 women, ranging in age from 65 to 84 years. The clinical diagnoses were a primary lung cancer in 6 cases and a solitary metastatic lung tumor in 4 cases. Eight single segmentectomies, one bi-segmentectomy, and one bi-subsegmentectomy were performed. Hilar lymphadenectomy with mediastinal lymph node sampling has been performed in 6 primary lung cancers, but four patients with metastatic lung tumors were performed without lymphadenectomy. The operation time and estimated blood loss ranged from 125 to 333 min and from 5 to 187 g, respectively. There were no intraoperative complications and no conversion to open thoracotomy and lobectomy. Postoperative courses of eight patients were uneventful, and another two patients had a prolonged lung air leak. The drainage duration and hospital stay ranged from 2 to 13 days and from 8 to 19 days, respectively. The tumor histology of primary lung cancer showed 5 adenocarcinoma and 1 squamous cell carcinoma. All primary lung cancers were at stage IA. The organs having metastatic pulmonary tumors were kidney, bladder, breast, and rectum. No patients had macroscopically positive surgical margins.

Conclusions

Binocular stereo-navigation was able to identify the bronchovascular structures accurately and suitable to perform TSLR with a sufficient margin for small pulmonary tumors.

【 授权许可】

   
2015 Kanzaki et al.; licensee BioMed Central.

【 图 表 】

Fig. 1.

Fig. 2.

【 参考文献 】

• [1]Nakayama H, Yamada K, Saito H, Oshita F, Ito H, Kameda Y et al.. Sublobar resection for patients with peripheral small adenocarcinomas of the lung: Surgical outcome is associated with features on computed tomographic imaging. Ann Thorac Surg. 2007; 84:1675-9.
• [2]Okada M, Yoshikawa K, Hatta T, Tsubota N. Is segmentectomy with lymph node assessment an alternative to lobectomy for non-small cell lung cancer of 2 cm or smaller? Ann Thorac Surg. 2001; 71:956-61.
• [3]Harada H, Okada M, Sakamoto T, Matsuoka H, Tsubota N. Functional advantage after radical segmentectomy versus lobectomy for lung cancer. Ann Thorac Surg. 2005; 80:2041-5.
• [4]De Giacomo T, Di Stasio M, Diso D, Anile M, Venuta F, Furio Coloni G. Sub-lobar lung resection of peripheral T1N0M0 NSCLC does not affect local recurrence rate. Scand J Surg. 2009; 98:225-8.
• [5]Gossot D, Ramos R, Brian E, Raynaud C, Girard P, Strauss C. A totally thoracoscopic approach for pulmonary anatomic segmentectomies. Interact Cardiovasc Thorac Surg. 2011; 12:529-32.
• [6]Ikeda N, Yoshimura A, Hagiwara M, Akata S, Saji H. Three dimensional computed tomography lung modeling is useful in simulation and navigation of lung cancer surgery. Ann Thorac Cardiovasc Surg. 2013; 19:1-5.
• [7]Oizumi H, Endoh M, Takeda S, Suzuki J, Fukaya K, Sadahiro M. Anatomical lung segmentectomy simulated by computed tomographic angiography. Ann Thorac Surg. 2010; 90:1382-3.
• [8]Oizumi H, Kanauchi N, Kato H, Endoh M, Suzuki J, Sadahiro M. Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: a report of 52 consecutive cases. J Thorac Cardiovasc Surg. 2011; 141:678-82.
• [9]Shimizu K, Nakano T, Kamiyoshihara M, Takeyoshi I. Segmentectomy guided by three-dimensional computed tomography angiography and bronchography. Interact Cardiovasc Thorac Surg. 2012; 15:194-6.
• [10]Saji H, Inoue T, Kato Y, Shimada Y, Hagiwara M, Kudo Y et al.. Virtual segmentectomy based on high-quality three-dimensional lung modelling from computed tomography. Interact Cardiovasc Thorac Surg. 2013; 17:227-32.
• [11]Eguchi T, Takasuna K, Kitazawa A, Fukuzawa Y, Sakaue Y, Yoshida K et al.. Thre-dimensional imaging navigation during a lung segmentectomy using an iPad. Eur J Cardiothorac Surg. 2012; 41:893-7.
• [12]Kanzaki M, Wachi N, Onuki T. Simulation video-assisted thoracoscopic lung resection using a virtual 3-dimensional pulmonary model on a personal computer. J Thorac Cardiovasc Surg. 2011; 142:243-4.
• [13]Kanzaki M, Kikkawa T, Shimizu T, Maeda H, Wachi N, Isaka T et al.. Presurgical planning using a three-dimensional pulmonary model of the actual anatomy of patient with primary lung cancer. Thorac Cardiovasc Surg. 2013; 61:144-50.
• [14]Kanzaki M, Maeda H, Wachi N, Kikkwa T, Komine H, Isaka T et al.. Complete video-assisted thoracoscopic multi-subsegmentectomy based on patients’ specific virtual 3-D pulmonary models. Asian J Endosc Surg. 2013; 6:110-5.
• [15]Matsumoto T, Kanzaki M, Amiki M, Shimizu T, Maeda H, Sakamoto K et al.. Comparison of three software programs for three-dimensional graphic imaging as contrasted with operative fields. Eur J Cardiothorac Surg. 2012; 41:1098-103.
• [16]Uchida M. Recent advances in 3D computed tomography techniques for simulation and navigation in hepatobiliary pancreatic surgery. J Hepatobillary Pancreat Sci. 2014; 21:239-45.
• [17]Kanzaki M, Kikkawa T, Sakamoto K, Maeda H, Wachi N, Komine H et al.. Three-dimensional simulation, surgical navigation, and thoracoscopic lung resection. J Surg Case Rep. 2013; 3:rjt015.
• [18]Nakada T, Akiba T, Inagaki T, Morikawa T. Thoracoscopic anatomical subsegmentectomy of the rightvS2b + S3 using a 3D printing model with rapid prototyping. Interact Cardiovasc Thorac Surg. 2014.