Feasibility Study Of Segmentectomy Guided By Surgical Planning Using Only Three-dimensional Reconstruction

Objective(s):With the progress of CT(Computed Tomography)technology and the development of cancer screening,lung cancer is more and more found in the early stage,and segmentectomy is more and more used in the surgical treatment of early non-small cell lung cancer(NSCLC).At present,3D(three dimensional,3D)reconstruction combined with CT-guided puncture location guidance for segmentectomy has achieved relatively successful results.On this basis,we want to explore the feasibility of using only three-dimensional reconstruction to guide segmentectomy.By comparing the perioperative indexes of VATS segmentectomy guided by single three-dimensional reconstruction technique and the combined use of CT-guided puncture location and three-dimensional reconstruction,to clear that for VATS segmentectomy,whether the preoperative planning with only three-dimensional reconstruction can achieve the same guiding effect as the combination of the two methods.Methods: From January 2022 to December 2022,78 patients who underwent VATS segmentectomy were divided into two groups according to the inclusion and exclusion criteria.The patients who completed 3D reconstruction with Mimics software for surgical planning were 35 patients in reconstruction group;43 patients were divided into combined group by using three-dimensional reconstruction and CT-guided puncture location for surgical planning.The scope of pulmonary segmental resection,the existence of variant blood vessels,preoperative,intraoperative and postoperative perioperative indexes were compared between the two groups,so as to evaluate the guiding effect of single three-dimensional reconstruction for surgical planning.Results: 1.The average operation time was 183.89 ± 79.17 min in the reconstruction group and 181.67 ±53.90 min in the combination group.There was no significant difference between the two groups(P>0.05).2.The average intraoperative bleeding was 150.00 ± 65.75 ml in the reconstruction group and 185.81 ±136.33 ml in the combined group.There was no significant difference between the two groups(P>0.05).3.There was no significant difference between the two groups in terms of patients’ general condition,tumor diameter,time with tube,drainage,hospital stay,perioperative secondary operation,perioperative death and so on(P > 0.05).4.1 case of vascular variation was found in the reconstruction group and 4 cases in the combined group.The two groups avoided massive hemorrhage and thoracotomy caused by vascular injury during the operation,and the operation was completed successfully.5.The surgical margin was planned before operation in both the reconstruction group and the combined group,and there were no positive cases during the operation.Conclusion(s): For surgeons who are experienced in surgery and familiar with pulmonary segmental anatomy,using only three-dimensional reconstruction to guide segmentectomy can achieve the same effect as the combined use of three-dimensional reconstruction and CT-guided puncture localization in locating pulmonary nodules and target pulmonary segments,reducing intraoperative bleeding and shortening operation time.At the same time,the single use of three-dimensional reconstruction can avoid the invasive risks and complications caused by CT-guided puncture location.Therefore,the single use of three-dimensional reconstruction for segmentectomy can achieve a good clinical guidance.