Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
Ann Thorac Surg. 2023 May;115(5):1247-1255. doi: 10.1016/j.athoracsur.2022.08.037. Epub 2022 Sep 6.
Lately, increased interest in pulmonary segmentectomy has been observed. Segmental border identification is extremely difficult on 2-dimensional computed tomography (CT). Preoperative application of virtual reality (VR) can provide better insight into patient-specific anatomy. The aim of this study was to investigate the added clinical value of 3-dimensional (3D) VR using PulmoVR for preoperative planning.
Patients with an indication for pulmonary segmentectomy were included between June 2020 and September 2021 at the Erasmus Medical Center, Rotterdam, The Netherlands. CT scans were (semi)automatically segmented to visualize lung segments, segmental arteries, veins, and bronchi. Three surgeons made a surgical plan on the basis of the conventional CT scan and subsequently analyzed the VR visualization. The primary outcome was the incidence of critical (ensuring radical resection) preoperative plan modifications. Secondarily, data on observed anatomic variation and perioperative (oncologic) outcomes were collected.
A total of 50 patients (median age at surgery, 65 years [interquartile range, 17.25 years]) with an indication for pulmonary segmentectomy were included. After supplemental VR visualization, the surgical plan was adjusted in 52%; the tumor was localized in a different segment in 14%, more lung-sparing resection was planned in 10%, and extended segmentectomy, including 1 lobectomy, was planned in 28%. Pathologic examination confirmed radical resection in 49 patients (98%).
This 3D VR technology showed added clinical value in the first 50 VR-guided segmentectomies because a 52% change of plan with 98% radical resection was observed. Furthermore, 3D VR visualization of the bronchovasculature, including various anatomic variations, provided better insight into patient-specific anatomy and offered lung-sparing possibilities with more certainty.
最近，人们对肺段切除术的兴趣有所增加。在二维计算机断层扫描（CT）上，节段边界的识别极为困难。虚拟现实（VR）的术前应用可以更好地了解患者的特定解剖结构。本研究旨在探讨使用 PulmoVR 进行术前规划的三维（3D）VR 的附加临床价值。
2020 年 6 月至 2021 年 9 月期间，荷兰鹿特丹伊拉斯谟医疗中心纳入了有肺段切除术适应证的患者。对 CT 扫描进行（半）自动分割，以可视化肺段、段动脉、静脉和支气管。三名外科医生根据常规 CT 扫描制定手术计划，然后分析 VR 可视化。主要结局是术前计划修改的发生率，包括危及生命（确保根治性切除）的修改。其次，收集观察到的解剖变异和围手术期（肿瘤学）结果的数据。
共纳入 50 例（手术时中位年龄 65 岁[四分位间距 17.25 岁]）有肺段切除术适应证的患者。在补充 VR 可视化后，52%的手术计划进行了调整；肿瘤位于不同的节段，14%的手术计划更注重保留肺组织，10%的手术计划进行了扩展段切除术，包括 1 例肺叶切除术，28%的手术计划进行了扩展段切除术。49 例（98%）患者的病理检查证实为根治性切除。
这项 3D VR 技术在 50 例 VR 引导下的段切除术中有附加的临床价值，因为有 52%的手术计划发生改变，且 98%的患者实现了根治性切除。此外，支气管血管的 3D VR 可视化，包括各种解剖变异，使患者的特定解剖结构有了更好的了解，并提供了更有把握的保留肺组织的可能性。
