Bhakhri Kunal, Hyde Eoin R, Mak Sze M, Berger Lorenz U, Ourselin Sebastien, Routledge Tom, Billè Andrea
Department of Thoracic Surgery, Guy's & St Thomas' Hospital, London, United Kingdom.
School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Front Surg. 2021 Mar 29;8:652428. doi: 10.3389/fsurg.2021.652428. eCollection 2021.
Interactive three-dimensional virtual models of pulmonary structures (3D-CT) may improve the safety and accuracy of robotic-assisted thoracic surgery (RATS). The aim of this study was to evaluate the impact of 3D-CT models as an imaging adjunct on surgical confidence and anatomical assessment for lobectomy planning. We retrospectively analyzed the response of 10 specialist thoracic surgeons who each reviewed 10 pre-operative images of patients undergoing robotic-assisted lobectomy lung cancer cases from June to November 2018 in our institute, resulting in 100 data points. The number of arteries, veins, and bronchi entering the resected lobes were determined from the operation video recording by the operating surgeon. 3D-CT models were generated for each case and made available for online visualization and manipulation. Thoracic surgeons were invited to participate in the survey which consisted of evaluation of CT (control) and 3D-CT (intervention) models. A questionnaire regarding anatomical structures, surgical approach, and confidence was administered. Ten participants were recruited. 3D-CT models led to a significant ( < 0.003) increase in the surgeons' ability to correctly identifying pulmonary arteries entering the resection lobes in 35% (CT) and 57% (3D-CT) of cases. A significant ( < 1e-13) improvement in anatomy assessment and surgical plan confidence was observed for the 3D-CT arm, with median Likert scale scores of "2-Slightly easy" (CT) and "4-Very easy" (3D-CT). The use of 3D-CT models for thoracic surgery planning increases the surgeon confidence in recognizing anatomical structures, largely by enhanced appreciation of anatomical variations in the segmental pulmonary arterial system. Further studies are needed to investigate if 3D-CT models can be used in providing precise information about segmental artery distribution and therefore surgical planning of sub-lobar resections.
肺部结构的交互式三维虚拟模型（3D-CT）可能会提高机器人辅助胸外科手术（RATS）的安全性和准确性。本研究的目的是评估3D-CT模型作为一种影像辅助手段对肺叶切除术规划中手术信心和解剖评估的影响。我们回顾性分析了10名胸外科专科医生的反馈，他们每人查看了2018年6月至11月在我院接受机器人辅助肺癌肺叶切除术患者的10张术前影像，共得到100个数据点。由主刀医生根据手术视频记录确定进入切除肺叶的动脉、静脉和支气管数量。为每个病例生成3D-CT模型，并提供在线可视化和操作功能。邀请胸外科医生参与该调查，调查包括对CT（对照）和3D-CT（干预）模型的评估。发放了一份关于解剖结构、手术方法和信心的问卷。招募了10名参与者。3D-CT模型使外科医生正确识别进入切除肺叶的肺动脉的能力显著提高（<0.003），在35%（CT）和57%（3D-CT）的病例中得以实现。3D-CT组在解剖评估和手术计划信心方面有显著改善（<1e-13），Likert量表中位数评分分别为“2-有点容易”（CT）和“4-非常容易”（3D-CT）。在胸外科手术规划中使用3D-CT模型可提高外科医生识别解剖结构的信心，这主要是通过增强对肺段动脉系统解剖变异的认识来实现的。需要进一步研究以调查3D-CT模型是否可用于提供有关肺段动脉分布的精确信息，从而用于亚肺叶切除术的手术规划。
