Application of preoperative localization coupled with CT three-dimensional reconstruction in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Tengteng ,  LIU Baodong , ZHANG Yi , SU Lei , LI Yuanbo , QIAN Kun

Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, P. R. China;

Corresponding author：

LIU Baodong, Email: xwliubaodong@aliyun.com

Keywords：

Preoperative localization; three-dimensional reconstruction; thoracoscopy; combined subsegmental/segmental resection

DOI：

10.7507/1007-4848.202201012

Video：

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Objective To assess the clinical value of preoperative localization coupled with computed tomography (CT) three-dimensional reconstruction in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection. Methods The clinical data of 30 patients of combined subsegmental/segmental resection in our hospital from December 2019 to October 2021 were retrospectively collected. There were 19 males and 11 females with the mean age of 56.4 (32.0-71.0) years. The pulmonary nodules were located by CT-guided injection of glue before operation. The three-dimensional reconstruction image and operation planning were carried out by Mimics 21.0 software. Results The operations were all successfully performed, and there was no conversion to open thoracotomy or lobectomy. The mean tumor diameter was 11.6±3.5 mm, the mean distance between the nodule and the visceral pleura was 13.6±5.6 mm, the mean width of the actual cutting edge was 25.0±6.5 mm, the mean operation time was 110.2±23.8 min, the mean number of lymph node dissection stations was 6.5±2.4, the mean amount of intraoperative bleeding was 50.8±20.3 mL, the mean retention time of thoracic catheter was 3.2±1.1 d, and the mean postoperative hospital stay was 4.5±1.7 d. There was 1 patient of subcutaneous emphysema, 1 patient of atrial fibrillation and 1 patient of blood in sputum. Conclusion Preoperative CT-guided injection of medical glue combined with CT three-dimensional reconstruction of pulmonary bronchus and blood vessels is safe and feasible in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection, which ensures the surgical margin and reserves lung tissues.

Citation： WANG Tengteng, LIU Baodong, ZHANG Yi, SU Lei, LI Yuanbo, QIAN Kun. Application of preoperative localization coupled with CT three-dimensional reconstruction in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(3): 364-368. doi: 10.7507/1007-4848.202201012 Copy

1.	赵俊松, 崔利, 何江波, 等. 上海22 351例无症状体检者低剂量CT肺癌筛查及随访结果初步分析. 诊断学理论与实践, 2019, 18(2): 183-188.
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3.	Asamura H, Okada M, Saji H, et al. Randomized trial of segmentectomy compared to lobectomy in small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). The 101st AATS conference. Oral presentation.
4.	钱坤, 支修益, 张毅, 等. CT 引导下注射医用胶在肺部小结节胸腔镜术前定位中的应用. 首都医科大学学报, 2015, 36(4): 529-532.
5.	李元博, 苏雷, 钱坤, 等. 肺小结节胸腔镜术前CT引导下注射医用胶定位的临床体会. 中国微创外科杂志, 2019, 19(12): 1125-1128.
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7.	支修益, 刘宝东. 肺癌诊治的两大理念: 微创和精准. 中国微创外科杂志, 2017, 17(1): 1-3.
8.	Gonzalez D, Delgado M, Paradela M, et al. Uni-incisional video-assisted thoracoscopic left lower lobectomy in a patient with an incomplete fissure. Innovations (Phila), 2011, 6(1): 45-47.
9.	Fu R, Zhang JT, Dong S, et al. Drainage tube hole suture improvement: Removal-free stitches. Thorac Cancer, 2019, 10(9): 1827-1833.
10.	任占良, 古轶, 任小朋, 等. 单孔胸腔镜肺良性疾病术后免胸管的临床疗效及安全性. 中国医师杂志, 2019, 21(7): 1083-1084.
11.	谢敬廉, 姚维深, 周国华, 等. 单孔胸腔镜与传统胸腔镜肺楔形切除术治疗肺部疾病的临床对比研究. 中国实用医药, 2019, 14(34): 4-6.
12.	钟楚澄, 胡婉玲. 单孔胸腔镜肺楔形切除术的临床效果分析. 中外医疗, 2020, 39(34): 22-25.
13.	王铁功, 金相兰, 詹茜, 等. CT引导下Hook wire术前定位在15 mm及以下肺结节的应用及预后评估. 中华介入放射学电子杂志, 2020, 8(1): 70-76.
14.	陈进, 吴娟, 胡冰宇, 等. 低剂量CT引导下注射医用胶在肺结节胸腔镜切除术前定位中的应用. 现代实用医学, 2020, 32(9): 1081-1083, 封3.
15.	郭坚溪, 张华, 肖伟俅, 等. 肺结节定位针在肺小结节术前定位的初步临床研究. 影像诊断与介入放射学, 2020, 29(5): 349-355.
16.	Okada M, Mimae T, Tsutani Y, et al. Segmentectomy versus lobectomy for clinical stage ⅠA lung adenocarcinoma. Ann Cardiothorac Surg, 2014, 3(2): 153-159.
17.	张真榕, 刘德若, 王晓伟, 等. 早期非小细胞肺癌外科治疗的荟萃分析. 中日友好医院学报, 2014, 28(4): 229-233.
18.	Winckelmans T, Decaluwé H, De Leyn P, et al. Segmentectomy or lobectomy for early-stage non-small-cell lung cancer: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2020, 57(6): 1051-1060.
19.	Hagiwara M, Shimada Y, Kato Y, et al. High-quality 3-dimensional image simulation for pulmonary lobectomy and segmentectomy: Results of preoperative assessment of pulmonary vessels and short-term surgical outcomes in consecutive patients undergoing video-assisted thoracic surgery. Eur J Cardiothorac Surg, 2014, 46(6): e120-e126.
20.	Kurenov SN, Ionita C, Sammons D, et al. Three-dimensional printing to facilitate anatomic study, device development, simulation, and planning in thoracic surgery. J Thorac Cardiovasc Surg, 2015, 149(4): 973-979.

1. 赵俊松, 崔利, 何江波, 等. 上海22 351例无症状体检者低剂量CT肺癌筛查及随访结果初步分析. 诊断学理论与实践, 2019, 18(2): 183-188.
2. Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
3. Asamura H, Okada M, Saji H, et al. Randomized trial of segmentectomy compared to lobectomy in small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). The 101st AATS conference. Oral presentation.
4. 钱坤, 支修益, 张毅, 等. CT 引导下注射医用胶在肺部小结节胸腔镜术前定位中的应用. 首都医科大学学报, 2015, 36(4): 529-532.
5. 李元博, 苏雷, 钱坤, 等. 肺小结节胸腔镜术前CT引导下注射医用胶定位的临床体会. 中国微创外科杂志, 2019, 19(12): 1125-1128.
6. 肺小结节术前辅助定位技术专家共识(2019版)专家组. 肺小结节术前辅助定位技术专家共识(2019版). 中国胸心血管外科临床杂志, 2019, 26(2): 109-113.
7. 支修益, 刘宝东. 肺癌诊治的两大理念: 微创和精准. 中国微创外科杂志, 2017, 17(1): 1-3.
8. Gonzalez D, Delgado M, Paradela M, et al. Uni-incisional video-assisted thoracoscopic left lower lobectomy in a patient with an incomplete fissure. Innovations (Phila), 2011, 6(1): 45-47.
9. Fu R, Zhang JT, Dong S, et al. Drainage tube hole suture improvement: Removal-free stitches. Thorac Cancer, 2019, 10(9): 1827-1833.
10. 任占良, 古轶, 任小朋, 等. 单孔胸腔镜肺良性疾病术后免胸管的临床疗效及安全性. 中国医师杂志, 2019, 21(7): 1083-1084.
11. 谢敬廉, 姚维深, 周国华, 等. 单孔胸腔镜与传统胸腔镜肺楔形切除术治疗肺部疾病的临床对比研究. 中国实用医药, 2019, 14(34): 4-6.
12. 钟楚澄, 胡婉玲. 单孔胸腔镜肺楔形切除术的临床效果分析. 中外医疗, 2020, 39(34): 22-25.
13. 王铁功, 金相兰, 詹茜, 等. CT引导下Hook wire术前定位在15 mm及以下肺结节的应用及预后评估. 中华介入放射学电子杂志, 2020, 8(1): 70-76.
14. 陈进, 吴娟, 胡冰宇, 等. 低剂量CT引导下注射医用胶在肺结节胸腔镜切除术前定位中的应用. 现代实用医学, 2020, 32(9): 1081-1083, 封3.
15. 郭坚溪, 张华, 肖伟俅, 等. 肺结节定位针在肺小结节术前定位的初步临床研究. 影像诊断与介入放射学, 2020, 29(5): 349-355.
16. Okada M, Mimae T, Tsutani Y, et al. Segmentectomy versus lobectomy for clinical stage ⅠA lung adenocarcinoma. Ann Cardiothorac Surg, 2014, 3(2): 153-159.
17. 张真榕, 刘德若, 王晓伟, 等. 早期非小细胞肺癌外科治疗的荟萃分析. 中日友好医院学报, 2014, 28(4): 229-233.
18. Winckelmans T, Decaluwé H, De Leyn P, et al. Segmentectomy or lobectomy for early-stage non-small-cell lung cancer: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2020, 57(6): 1051-1060.
19. Hagiwara M, Shimada Y, Kato Y, et al. High-quality 3-dimensional image simulation for pulmonary lobectomy and segmentectomy: Results of preoperative assessment of pulmonary vessels and short-term surgical outcomes in consecutive patients undergoing video-assisted thoracic surgery. Eur J Cardiothorac Surg, 2014, 46(6): e120-e126.
20. Kurenov SN, Ionita C, Sammons D, et al. Three-dimensional printing to facilitate anatomic study, device development, simulation, and planning in thoracic surgery. J Thorac Cardiovasc Surg, 2015, 149(4): 973-979.

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Application of preoperative localization coupled with CT three-dimensional reconstruction in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection

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