Virtual Navigation Technology for the Functional Restoration of Anastomosis in Oncologic Pulmonary Surgery

A 44-year-old woman, former smoker, underwent apical segmentectomy of the right lower lobe in 2015 for a typical carcinoid tumor (1.5 cm, Ki 67 < 2%, T1aN0M0R1). In 2024, follow-up CT revealed a suspicious lesion, and PET scan confirmed a 13 mm nodule (SUVmax 6). In January 2025, she had an extended right lower lobectomy with bronchoplasty. Weeks later, flexible bronchoscopy showed reduced bronchial lumen, partially visualizing the middle lobe bronchi (ML). Two months post-surgery, due to increasing dyspnea, an almost complete distal stenosis of the intermediate bronchus was discovered, preventing access to the ML. After unsuccessful balloon dilation and anatomical uncertainty, the procedure was stopped. CT with 3D reconstruction (Fujifilm Synapse 3D software) and virtual bronchoscopy navigation (VBN) was performed with this planner. Guided by VBN, biopsies and successful balloon dilation reopened the ML bronchial orifice. The case highlights the value of VBN and 3D reconstruction for planning and guiding complex endoscopic procedures.