Intraoperative recall of surgeon-defined 3-dimensional planning during robotic pulmonary resection: A feasibility...

To evaluate the feasibility, usability, and user acceptance of integrating preoperative patient-specific 3-dimensional planning into an intraoperative stereoscopic robotic workflow during pulmonary resection.

We conducted a prospective single-center pilot study of patients scheduled to undergo robot-assisted pulmonary lobectomy or anatomical segmentectomy. Patient-specific pulmonary anatomical models were generated preoperatively and displayed intraoperatively on the robotic surgeon's console using an i-Lung 3-dimensional simulator. Planned transection references for the vascular and bronchial structures were defined using cut rings and recalled during surgery. Questionnaire responses from surgeons and assistants were prospectively collected after each procedure. The outcomes were summarized using descriptive statistics, and no formal hypothesis testing was performed.

Sixteen consecutive patients were enrolled; 1 procedure was aborted because of unexpected pleural dissemination. The remaining 15 patients were analyzed. The system was successfully introduced in all 15 procedures, with no conversions, procedure interruptions, technical failures, system crashes, or image display interruptions attributable to the system. All surgeon responses indicated anatomical consistency, no rendering delay interfering with surgery, and no significant visual discomfort. Surgeon-rated depth perception and usefulness of console-based anatomical confirmation were rated 5 in 13 responses and 4 in 2 responses. Interactive functions and future-use items were rated 5 in all surgeon responses. Assistant responses also favored shared stereoscopic visualization.

The i-Lung 3-dimensional simulator enabled feasible integration of preoperative patient-specific 3-dimensional planning into the intraoperative stereoscopic robotic console environment. Further studies with objective endpoints are warranted.