[Digital Innovation for Lung Segmentectomy for Early-stage Small Lung Cancer]

In recent years, the number of cases of small-size lung cancer(<2 cm) has increased with the widespread of computed tomography (CT) in medical checkup and comprehensive medical checkup. Although lobectomy has been the standard surgical treatment for early-stage small-size lung cancer, it has become possible to evaluate the CT findings of small tumors in terms of ground-glass areas and solid areas, and it has become clear that the former has a low histological malignancy while the latter has a high malignancy. Lung cancers with high ground-glass opacity have low malignant potential and are therefore being aggressively treated by limited resection. The number of lung segmentectomies is expected to increase in the future, and accurate identification of pulmonary intersegmental planes is important in this operation. Especially in thoracoscopic surgery, where the field of view and surgical operation are limited, tumor localization and intersegmental planes identification are particularly important and require preoperative and intraoperative planning. In order to perform safe and reliable lung segmentectomy, we create a three-dimensional (3D) lung model by Synapse Vincent for preoperative simulation of pulmonary vascular, tumor location, and intersegmental plane. In addition, preoperative simulations are performed using wearable goggles to freely move the 3D lung model in a virtual reality (VR) space. Intraoperatively, in addition to indocyanine green (ICG)-based intersegmental identification, digital assistance is used for tumor and intersegmental identification using mixed reality( MR) goggles. We describe the current status and future prospects of segmentectomy in our institution.