Jeremy L C Smelt1, Tanay Suri2, Oswaldo Valencia3, Marjan Jahangiri3, Kawal Rhode2, Arjun Nair4, Andrea Bille5. 1. Department of Thoracic Surgery, Guy's and St Thomas' Hospital National Health Service Foundation Trust, London. Electronic address: jeremy.smelt@stgeorges.nhs.uk. 2. Department of Biomedical Engineering, King's College London, London. 3. Department of Cardiothoracic Surgery, St. George's Hospital, London. 4. Department of Radiology, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom. 5. Department of Thoracic Surgery, Guy's and St Thomas' Hospital National Health Service Foundation Trust, London.
Abstract
BACKGROUND: Careful preoperative planning in thoracic surgery is essential for positive outcomes, especially in video-assisted thoracic surgery (VATS), where palpation and 3-dimensional (3D) imaging is restricted. This study evaluated the ability of different imaging techniques, such as computed tomography (CT) scanning, maximal intensity projection imaging, 3D reconstruction, and 3D printing, to define the anatomy of the hilar structures before anatomical lung resection. METHODS: All patients undergoing elective lung resections by VATS for cancer under a single surgeon were identified over a 3-month period. The surgeon was asked to record the number of pulmonary artery branches supplying the lobe to be resected by using the preoperative CT scans, maximal intensity projection images, and 3D-reconstructed CT images. The lung hilum in 3 patients was printed. These were then compared with the intraoperative findings. RESULTS: The preoperative imaging of 16 patients was analyzed. The lung hilum was printed in a further 3 patients. Although not statistically significant, the 3D prints of the hilum were the most accurate measurement, with a correlation of 0.92. CT, 3D-reconstructed CT, and maximal intensity projection images tended to underrecognize the number of arterial branches and therefore scored between 0.26 and 0.39 in absolute agreement with the number of arteries found at operation. CONCLUSIONS: 3D printing in the planning of thoracic surgery may suggest a benefit over contemporary available imaging modalities, and the use of 3D printing in practicing operations is being established.
BACKGROUND: Careful preoperative planning in thoracic surgery is essential for positive outcomes, especially in video-assisted thoracic surgery (VATS), where palpation and 3-dimensional (3D) imaging is restricted. This study evaluated the ability of different imaging techniques, such as computed tomography (CT) scanning, maximal intensity projection imaging, 3D reconstruction, and 3D printing, to define the anatomy of the hilar structures before anatomical lung resection. METHODS: All patients undergoing elective lung resections by VATS for cancer under a single surgeon were identified over a 3-month period. The surgeon was asked to record the number of pulmonary artery branches supplying the lobe to be resected by using the preoperative CT scans, maximal intensity projection images, and 3D-reconstructed CT images. The lung hilum in 3 patients was printed. These were then compared with the intraoperative findings. RESULTS: The preoperative imaging of 16 patients was analyzed. The lung hilum was printed in a further 3 patients. Although not statistically significant, the 3D prints of the hilum were the most accurate measurement, with a correlation of 0.92. CT, 3D-reconstructed CT, and maximal intensity projection images tended to underrecognize the number of arterial branches and therefore scored between 0.26 and 0.39 in absolute agreement with the number of arteries found at operation. CONCLUSIONS: 3D printing in the planning of thoracic surgery may suggest a benefit over contemporary available imaging modalities, and the use of 3D printing in practicing operations is being established.
Authors: Marco Sperandeo; Elisabettamaria Frongillo; Lucia Maria Cecilia Dimitri; Anna Simeone; Salvatore De Cosmo; Marco Taurchini; Cristiana Cipriani Journal: J Ultrasound Date: 2019-03-23