Kanzaki Masato, Isaka Tamami, Kikkawa Takuma, Sakamoto Kei, Yoshiya Takehito, Mitsuboshi Shota, Oyama Kunihiro, Murasugi Masahide, Onuki Takamasa
Department of Surgery I, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
BMC Surg. 2015 May 8;15:56. doi: 10.1186/s12893-015-0044-y.
This study investigated the efficacy of binocular stereo-navigation during three-dimensional (3-D) thoracoscopic sublobar resection (TSLR).
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.
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.
Binocular stereo-navigation was able to identify the bronchovascular structures accurately and suitable to perform TSLR with a sufficient margin for small pulmonary tumors.
本研究调查了三维（3-D）胸腔镜下肺段切除术（TSLR）中双目立体导航的疗效。
从2001年7月起，作者所在科室开始在个人电脑（PC）上使用虚拟3-D肺模型进行胸腔镜肺切除术前的模拟以及术中导航。利用120张1毫米薄层高分辨率计算机断层扫描（HRCT）的肿瘤及肺门图像，自制软件CTTRY允许外科医生在HRCT图像上手动标记肺动脉、肺静脉、支气管和肿瘤。肺血管和支气管的位置及厚度被呈现为不同大小的圆柱体。利用所得的数值数据，通过Metasequoia共享软件重建三维图像。随后，将重建的三维图像数据转换为Autodesk数据，并显示在立体视觉显示器上。佩戴3-D偏振眼镜的外科医生进行3-D TSLR手术。
患者包括5名男性和5名女性，年龄在65至84岁之间。临床诊断为原发性肺癌6例，孤立性肺转移瘤4例。共进行了8例单肺段切除术、1例双肺段切除术和1例双亚肺段切除术。6例原发性肺癌患者进行了肺门淋巴结清扫及纵隔淋巴结采样，但4例肺转移瘤患者未进行淋巴结清扫。手术时间和估计失血量分别为125至333分钟和5至187克。术中无并发症发生，也未转为开胸手术和肺叶切除术。8例患者术后恢复顺利，另外2例患者出现了较长时间的肺漏气。引流时间和住院时间分别为2至13天和8至19天。原发性肺癌的肿瘤组织学显示5例为腺癌，1例为鳞状细胞癌。所有原发性肺癌均为IA期。发生肺转移瘤的器官为肾脏、膀胱、乳腺和直肠。所有患者手术切缘肉眼均为阴性。
双目立体导航能够准确识别支气管血管结构，适用于对小的肺部肿瘤进行具有足够切缘的TSLR手术。
