Operative Planning in Thoracic Surgery: A Pilot Study Comparing Imaging Techniques and Three-Dimensional Printing

Area of Science:

• Thoracic Surgery
• Medical Imaging
• Anatomical Reconstruction

Background:

• Preoperative planning is crucial for successful thoracic surgery, especially in video-assisted thoracic surgery (VATS) due to limited tactile and 3D visualization.
• Accurate definition of hilar structures is essential for anatomical lung resection.

Purpose of the Study:

• To evaluate the efficacy of various imaging techniques including computed tomography (CT), maximal intensity projection (MIP), 3D reconstruction, and 3D printing in defining hilar anatomy prior to anatomical lung resection.
• To compare the accuracy of these imaging modalities against intraoperative findings.

Main Methods:

• Retrospective analysis of 16 patients undergoing elective VATS lung resections for cancer.
• Preoperative CT scans, MIP images, and 3D-reconstructed CT images were used to count pulmonary artery branches supplying the target lobe.
• 3D printing of the lung hilum was performed for 3 patients and compared with intraoperative findings.

Main Results:

• 3D printed models showed the highest accuracy (correlation of 0.92) in representing hilar anatomy, although not statistically significant.
• CT, 3D-reconstructed CT, and MIP images tended to underestimate the number of arterial branches, with scores between 0.26 and 0.39 in absolute agreement.
• Intraoperative findings were compared to preoperative imaging assessments.

Conclusions:

• Three-dimensional printing shows potential as a superior imaging modality for preoperative planning in thoracic surgery compared to current methods.
• The application of 3D printing in surgical practice is increasingly recognized for its benefits in complex procedures.