Feng Zhen, Yu Shuliang, Diao Haixiao, Yu Yue, Peng Zhongmin
Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Province, China.
Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Province, China.
JTCVS Tech. 2022 Dec 17;18:130-136. doi: 10.1016/j.xjtc.2022.11.015. eCollection 2023 Apr.
The intraoperative localization of nonpalpable pulmonary nodules for thoracoscopic wedge resection is technically challenging. Current preoperative image-guided localization techniques require additional time, costs, procedural risks, advanced facilities, and well-trained operators. In this study, we explored a cost-effective method of well-matched interaction between virtuality and reality for accurate intraoperative localization.
Through the integration of techniques involving preoperative 3-dimensional (3D) reconstruction, temporary clamping of target vessel and the modified inflation-deflation method, the segment on the 3D virtual model and the segment under the thoracoscopic monitor were well matched in the inflated state. Then the spatial relationships of target nodule to the virtual segment could be applied to the actual segment. The well-matched interaction between virtuality and reality would facilitate nodule localization.
A total of 53 nodules were successfully localized. The median maximum diameter of the nodules was 9.0 mm (interquartile range [IQR], 7.0-12.5 mm). The median depth and depth were 10.0 mm and 18.2 mm, respectively. The median macroscopic resection margin was 16 mm (IQR, 7.0-12.5 mm). The median duration of chest tube drainage was 27 hours, with a median total drainage of 170 mL. The median postoperative length of hospital stay was 2 days.
The well-matched interaction between virtuality and reality is safe and feasible for intraoperative localization of nonpalpable pulmonary nodules. It may be proposed as a preferred alternative to traditional localization methods.
对于胸腔镜楔形切除术而言，术中定位不可触及的肺结节在技术上具有挑战性。当前的术前影像引导定位技术需要额外的时间、成本、操作风险、先进设备以及训练有素的操作人员。在本研究中，我们探索了一种在虚拟与现实之间实现良好匹配交互以进行准确术中定位的经济有效方法。
通过整合术前三维（3D）重建、目标血管临时夹闭以及改良的充气-放气方法等技术，在充气状态下，3D虚拟模型上的节段与胸腔镜监测下的节段实现了良好匹配。然后，目标结节与虚拟节段的空间关系可应用于实际节段。虚拟与现实之间的良好匹配交互将有助于结节定位。
共成功定位53个结节。结节的最大直径中位数为9.0毫米（四分位间距[IQR]，7.0 - 12.5毫米）。深度中位数和厚度中位数分别为10.0毫米和18.2毫米。宏观切缘中位数为16毫米（IQR，7.0 - 12.5毫米）。胸腔闭式引流的持续时间中位数为27小时，总引流量中位数为170毫升。术后住院时间中位数为2天。
虚拟与现实之间的良好匹配交互对于不可触及肺结节的术中定位是安全可行的。它可被提议作为传统定位方法的首选替代方案。
