Three-dimensional reconstruction/personalized three-dimensional printed model for thoracoscopic anatomical partial-lobectomy in stage I lung cancer: a retrospective study

Abstract

Background: Considering the complexity of vascular or bronchial variations and the difficulty of nodule localization during segmental resection, the three-dimensional (3D) reconstruction and printing model can provide a guarantee for safe operation and, to some extent, can simplify the surgical procedure. We conducted this study to estimate the avail of 3D reconstruction and personalized model in anatomical partial-lobectomy (APL).

Methods: We prospectively collected and retrospectively reviewed the data of 298 cases who underwent APL in our institute from April 2017 to May 2019. The patients were divided into "3D-reconstruction" group (131 patients), "3D model" group (31 patients) and "non-3D" group (136 patients). We adopted the ANOVA analysis and Chi-square test to compare the perioperative data between the three groups. Subjective satisfaction questionnaires for surgeons were provided to evaluate the value of personalized 3D printed model.

Results: The proportion of complex segmentectomy in 3D model group (87.1%) was significantly higher than that in the 3D-reconstruction group (60.3%) and non-3D group (55.9%) (P=0.006), and the average operation time of complex segmentectomy in 3D model group (99.56 minutes) was significantly shorter than that of the other group (all P<0.05). The average intraoperative blood loss in the 3D model group (12.9 mL) was significantly lower than that in the 3D reconstruction group (20.9 mL) (P=0.001) and non-3D group (18.2 mL) (P=0.022). For simple segmentectomy, the operation time, postoperative drainage, and postoperative hospital stay were similar among the three groups. The questionnaire survey showed that most surgeons were satisfied with the clinical effectiveness of the personalized 3D printed model.

Conclusions: 3D printing technology can improve understanding of the anatomy, decrease the operation time, and reduce the potential risk of thoracoscopic anatomical partial lobectomy in stage I lung cancer. A pre-operative rating scale was designed to standardize the application of this technology.

Keywords: Anatomical partial-lobectomy (APL); lung cancer; three-dimensional printing (3D printing).

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tlcr-20-571). The authors have no conflicts of interest to declare.

2020 Translational Lung Cancer Research. All rights reserved.

Figures

Figure 1

The CT scan, 3D simulation, and 3D model of a 43-year-old female patient. One lesion was found in the left lower lobe. According to the scrutiny of 3D simulation and 3D model, anatomical partial lobectomy with left S8a + S9a (LS8a + LS9a) was performed. Postoperative pathological results showed that the lesion was adenocarcinoma in situ (AIS). The resection margin distance was more than 2 cm. (A) CT scans showed that a thin-walled cystic lesion was located in the left lobe (S8a + S9a); (B) the reconstructed image showed the relationship between lesion and arteries; (C) 3D reconstruction imaging showed the location relationship between the lesion and pulmonary veins; (D) planning resection region and target lung segment by 3D simulation; (E) personalization 3D printed model; (F) place the 3D model in front of the video-assisted thoracoscopic display for real-time intraoperative reference.

Video 1

Anatomical partial lobectomy with left S8a+S9a.

Figure 2

Doctor’s subjective questionnaire.