Intraoperative Computed Tomography Navigation During Thoracoscopic Segmentectomy for Small-sized Lung Tumors

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Medical Imaging

Background:

• Video-assisted thoracoscopic surgery (VATS) pulmonary segmentectomy is increasingly used for lung cancer and metastases.
• Identifying intersegmental lines can be challenging in patients with emphysema.
• Securing adequate surgical margins for nonpalpable lesions is often uncertain.

Purpose of the Study:

• To evaluate the efficacy of intraoperative computed tomography (CT) scans during VATS pulmonary segmentectomy.
• To assess the utility of intraoperative CT for anatomical landmark identification and margin assessment.

Main Methods:

• A study involving 12 patients undergoing intraoperative CT-assisted VATS segmentectomy.
• Intraoperative CT scans performed under bilateral lung ventilation after vessel and bronchial division.
• Use of intraoperative CT or 3D CT reconstruction images for anatomical confirmation and margin assessment.

Main Results:

• All patients had confirmed lesion location, intersegmental borders, and surgical margins during VATS segmentectomy.
• Complete resection was achieved in all 12 patients.
• Strong correlation (r=0.963, P<0.0001) between intraoperative CT surgical margins and final pathologic margins, though pathologic margins were shorter.

Conclusions:

• Intraoperative CT scans are valuable for identifying nonpalpable lesions and confirming anatomical borders in VATS segmentectomy.
• This technique aids in securing resection margins, leading to more definitive procedures.
• Intraoperative CT navigation enhances the precision of VATS segmentectomy, especially for challenging cases.