[Simulation of thoracoscopic esophagectomy by three-dimensional computed tomography]

The virtual operative field of thoracoscopic surgery for esophageal cancer was created by three-dimensional (3D) computed tomography (CT) imaging. Major vessels, bone, trachea, bronchi, lung, esophagus, lymph nodes and broncial arteries were constructed by a Zio M900 workstation from multidetector-row CT scanning data. The mediastinal lymph nodes and bilateral bronchial arteries were drawn by a free-hand tool. The static images and fry-through movies by a virtual endoscopy mode were useful for simulation of the endoscopic surgery, which is usually performed in very limited viewing. The location of lymph nodes and bronchial arteries in relation to the adjacent anatomical structures was realized by this virtual vision. The bronchial arteries should be preserved to avoid tracheobronchial ischemia, especially in case of salvage surgery after definitive chemoradiotherapy. The left bronchial arteries had many anatomical variations, so that 3D CT images were helpful to identify and to preserve the left bronchial arteries. In conclusion, the simulation of thoracoscopic esophagectomy by 3D CT is thought to contribute to safty and precise navigation for this kind of surgery.