Use of Advanced Virtual Reality and Interactive 3D Technology in Complex S3 Segmentectomy
Recently, there has been a worldwide increase in the number of segmentectomies for early-stage I primary lung cancer, intrapulmonary metastases, and benign disease limited to segmental borders and not suitable for wedge resection (1,2). As a result, residents, trainees, and young surgeons in the fields of cardiothoracic and thoracic surgery are getting more exposed to these technically challenging procedures.
Surgical planning and awareness of patient-specific anatomy are essential factors for the preoperative planning of pulmonary segmentectomies (3,4). In addition, intraoperative guidance by patient-specific virtual 3D models could potentially enhance procedural safety and surgeon satisfaction. Virtual reality and interactive 3D imaging technology could significantly contribute to our understanding of the complex pulmonary bronchovascular anatomy and could facilitate personalized and patient-specific surgical planning for patients undergoing these procedures (5).
Therefore, the authors of this article have codeveloped a virtual reality and artificial intelligence-based platform called PulmoVR (jointly developed by their department, MedicalVR (Amsterdam, the Netherlands), Thirona (Nijmegen, The Netherlands), and Fysicon EVOCS (Oss, The Netherlands)) that enables review of CT-scans in an immersive three-dimensional environment (5). It also facilitates patient-specific surgical planning and creates 3D models (Pulmo3D) that can be used for intraoperative anatomical and surgical guidance.
This video reviews how PulmoVR and Pulmo3D have contributed to the planning and execution of a complex video-assisted thoracoscopic surgical (VATS) S3 segmentectomy. Through this, a brief 3D review of right upper lobe bronchovascular anatomy is provided. Moreover, the authors present the surgical steps of a complex right upper lobe S3 segmentectomy in a fissureless lung, assisted with intraoperative 3D guidance and indocyanine-green (ICG). Through this video, the authors hope to stimulate the use of advanced 3D technology for both resident teaching and surgical planning.
1. Yang CF, D'Amico TA. Thoracoscopic segmentectomy for lung cancer. Ann Thorac Surg. 2012; 94(2):668-81.
2. Ghaly G, Kamel M, Nasar A, et al. Video-assisted thoracoscopic surgery is a safe and effective alternative to thoracotomy for anatomical segmentectomy in patients with clinical stage I non-small cell lung cancer. Ann Thorac Surg. 2016;101(2):465-72.
3. Oizumi H, Kanauchi N, Kato H, et al. Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: a report of 52 consecutive cases. J Thorac Cardiovasc Surg. 2011;141(3):678-82.
4. Sardari Nia P, Olsthoorn JR, Heuts S, Maessen JG. Interactive 3D reconstruction of pulmonary anatomy for preoperative planning, virtual simulation, and intraoperative guiding in video-assisted thoracoscopic lung surgery. Innovations. 2019;14(1):17-26..
5. Sadeghi AH, Maat APWM, Taverne JHJ, et al. Virtual reality and artificial intelligence for 3D planning of lung segmentectomies. JTCVS Techniques. 2021;16;7:309-321.