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Introduction
Recent advances in high-resolution computed tomography (HRCT) allow surgeons to construct three-dimensional (3D) images of lung structures based on computed tomography (CT) images pre-operatively. In fact, several reports in the field of thoracoscopic segmentectomy addressed the usefulness of pre- or intra-operative use of 3D evaluation and simulation [1–7]. We developed a novel simulation system that is especially focused on pulmonary segmentectomy based on high-quality 3D lung modeling from CT images using the software REVORAS™ (Ziosoft, Inc., Tokyo, Japan). In this report, we introduce a novel 3D segmentectomy simulation and show anatomical accuracy in detecting pulmonary artery and vein by the new software.
Technique
Contrast-enhanced HRCT imaging data were transferred to a workstation with the novel 3D image-processing software REVORAS™. The 3D images of the pulmonary lobes, vessels, and bronchial trees were constructed automatically in a few minutes. Using the 3D images, surgeons were able to simulate the operative procedure (Supplemental Video). The actual process of 3D image simulation of segmentectomy was as follows: (i) transfer of the Digital Imaging and Communications in Medicine data of the CT images to the 3D imaging system; (ii) 3D reconstruction of the pulmonary vessels, tracheobronchial tree, and lung parenchyma; (iii) recognition of the target lesion semi-automatically and determination of the segments to be resected based on the location of the lesion and the planned surgical margin; and (iv) 3D image visualization of the appropriate segmentectomy surface (Fig. 1). In the stump view mode, which is a novel demonstration mode that was developed with surgeons’ perspective to help surgeons understand the 3D positional relationship of the hilar vessels and the bronchus (Fig. 2), the segmental vessels and bronchus to be resected are displayed as small circles that indicate the resected stump. The vessels and bronchus distal to the stump are intentionally hidden. Surgeons can avoid overlapping display and understand the positional relationships of the hilar vessels and bronchus more clearly and can simulate the operative procedures in the actual order of dissection.
Fig. 1 [Images not available. See PDF.]
The actual process of constructing 3D image simulation of segmentectomy from late contrast-enhanced HRCT. i Transfer of DICOM data of CT images to the 3D imaging system; ii 3D reconstruction of the pulmonary vessels, tracheo-bronchial tree and lung parenchyma; iii