Clinical application of three-dimensional computed tomography bronchography and angiography in robotic lung segmentectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TAO Shaolin , KANG Poming , LI Qingyuan , JIANG Bin , SHEN Cheng , FENG Yonggeng , FANG Chunshu , WU Licheng , WANG Ruwen , DENG Bo ,  TAN Qunyou

Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, P.R.China;

Corresponding author：

TAN Qunyou, Email: tanqy001@163.com

Keywords：

Pulmonary nodule; lung segmentectomy; 3D-CTBA; robot-assisted surgery

DOI：

10.7507/1007-4848.202005010

Video：

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Objective To explore the clinical value of three-dimensional computed tomography bronchography and angiography (3D-CTBA) in robotic lung segmentectomy.Methods A non-randomized control study was performed and continuously enrolled 122 patients who underwent robotic lung segmentectomy in our hospital from January 2019 to January 2020. 3D-CTBA was performed before operations in 53 patients [a 3D-CTBA group, including 18 males, 35 females, with a median age of 52 (26-69) years] and not performed in the other 69 patients [a traditional group, including 23 males, 46 females, with a median age of 48 (30-76) years]. The clinical data of the patients were compared between the two groups.Results All the patients were successfully completed the surgery and recovered from hospital, with no perioperative death. The baseline characteristics of the patients were not significantly different between the two groups (P>0.05). No significant difference was found in the operative time [120 (70-185) min vs. 120 (45-225) min, P=0.801], blood loss [50 (20-300) mL vs. 30 (20-400) mL, P=0.778], complications rate (17.0% vs. 11.6%, P=0.162), postoperative hospital stay [7 (4-19) d vs. 7 (3-20) d, P=0.388] between the two groups. In the 3D-CTBA group, 5 (9.4%) patients did not find nodules after segmentectomy, and only 1 (1.9%) of them needed lobectomy, but in the traditional group, 8 (11.6%) patients did not find nodules and had to carry out lobectomy, the difference was statistically significant (P<0.05). The follow-up time was 10 (1-26) months, and during this period, there was no recurrence, metastasis or death in the two groups.Conclusion 3D-CTBA is helpful for accurate localization of nodules and reasonable surgical planning before operations, and reducing wrong resections in segmentectomy, without increasing the operation time, blood loss and complications. It is safe and effective in anatomical lung segmentectomy.

Citation： TAO Shaolin, KANG Poming, LI Qingyuan, JIANG Bin, SHEN Cheng, FENG Yonggeng, FANG Chunshu, WU Licheng, WANG Ruwen, DENG Bo, TAN Qunyou. Clinical application of three-dimensional computed tomography bronchography and angiography in robotic lung segmentectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(10): 1155-1160. doi: 10.7507/1007-4848.202005010 Copy

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23.	Carcoforo P, Feo C, Sortini D, <italic>et al</italic>. Localization of pulmonary nodules. Chest, 2004, 125(2): 796.
24.	Barmin V, Sadovnichy V, Sokolov M, <italic>et al</italic>. An original device for intraoperative detection of small indeterminate nodules? Eur J Cardiothorac Surg, 2014, 46(6): 1027-1031.
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1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin, 2020, 70(1): 7-30.
2. 周清华, 范亚光, 王颖, 等. 中国肺部结节分类、诊断与治疗指南(2016 年版). 中国肺癌杂志, 2016, 19(12): 793-798.
3. MacMahon H, Naidich DP, Goo JM, <italic>et al</italic>. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 2017, 284(1): 228-243.
4. D'Andrilli A, Rendina EA. Should segmentectomy rather than lobectomy be the operation of choice for early-stage non-small cell lung cancer? Yes. Chest, 2018, 153(3): 590-592.
5. Cao J, Yuan P, Wang Y, <italic>et al</italic>. Survival rates after lobectomy, segmentectomy, and wedge resection for non-small cell lung cancer. Ann Thorac Surg, 2018, 105(5): 1483-1491.
6. NCCN clinical practice guidelines in oncology: Non-small cell lung cancer (version 1.2018). URL: http://www.jnccn.org.
7. 王群, 蒋伟, 王琳, 等. 肺部磨玻璃结节的处理原则和共识及手术技巧. 中华肿瘤杂志, 2019, 41(1): 6-9.
8. She XW, Gu YB, Xu C, <italic>et al</italic>. Three-dimensional (3D)- computed tomography bronchography and angiography combined with 3D-video-assisted thoracic surgery (VATS) versus conventional 2D-VATS anatomic pulmonary segmentectomy for the treatment of non-small cell lung cancer. Thorac Cancer, 2018, 9(2): 305-309.
9. 支修益, 胡坚, 刘伦旭, 等. 人工智能平台下肺结节的三维可视化定位与手术规划专家共识. 中国胸心血管外科临床杂志, 2019, 26(12): 1161-1166.
10. 陶绍霖, 康珀铭, 谭群友, 等. 经前侧入路达芬奇机器人辅助肺段切除术的临床分析. 中国胸心血管外科临床杂志, 2020, 27(2): 178-182.
11. Suzuki K, Saji H, Aokage K, <italic>et al</italic>. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
12. 陈亮, 王俊, 吴卫兵, 等. 胸腔镜精准肺段切除术技术流程和质量控制. 中国胸心血管外科临床杂志, 2019, 26(1): 21-28.
13. Sato M. Precise sublobar lung resection for small pulmonary nodules: localization and beyond. Gen Thorac Cardiovasc Surg, 2020, 68(7): 684-691.
14. 初向阳, 侯晓彬, 张连斌, 等. CT引导下 Hook-wire 定位肺磨玻璃样微小结节微创切除的临床研究. 中国肺癌杂志, 2014, 17(12): 845-849.
15. 姜格宁, 陈昶, 朱余明, 等. 上海市肺科医院磨玻璃结节早期肺腺癌的诊疗共识(第一版). 中国肺癌杂志, 2018, 21(3): 147-159.
16. Li C, Liu B, Jia H, <italic>et al</italic>. Computed tomography-guided hook wire localization facilitates video-assisted thoracoscopic surgery of pulmonary ground-glass nodules. Thorac Cancer, 2018, 9(9): 1145-1150.
17. Hwang S, Kim TG, Song YG. Comparison of hook wire versus coil localization for video-assisted thoracoscopic surgery. Thorac Cancer, 2018, 9(3): 384-389.
18. 张磊, 谢冬, 陈昶. 肺磨玻璃结节术中定位方法的应用进展. 中国胸心血管外科临床杂志, 2018, 25(12): 1080-1084.
19. 宋铁牛, 李斌, 夏学阳, 等. 医用胶在肺微小结节术前定位中的应用. 中国胸心血管外科临床杂志, 2018, 25(4): 354-356.
20. Ishiwata T, Gregor A, Inage T, <italic>et al</italic>. Bronchoscopic navigation and tissue diagnosis. Gen Thorac Cardiovasc Surg, 2020, 68(7): 672-678.
21. Qian K, Deng Y, Shen C, <italic>et al</italic>. Combination of electromagnetic navigation bronchoscopy-guided biopsy with a novel staining for peripheral pulmonary lesions. World J Surg Oncol, 2019, 17(1): 158.
22. 王柏霖, 申磊磊, 林吉兴, 等. 肺小结节胸腔镜手术术前定位方法研究进展. 武警医学, 2019, 30(1): 79-82.
23. Carcoforo P, Feo C, Sortini D, <italic>et al</italic>. Localization of pulmonary nodules. Chest, 2004, 125(2): 796.
24. Barmin V, Sadovnichy V, Sokolov M, <italic>et al</italic>. An original device for intraoperative detection of small indeterminate nodules? Eur J Cardiothorac Surg, 2014, 46(6): 1027-1031.
25. Zhang L, Li M, Li Z, <italic>et al</italic>. Three-dimensional printing of navigational template in localization of pulmonary nodule: A pilot study. J Thorac Cardiovasc Surg, 2017, 154(6): 2113-2119.
26. Wu WB, Xia Y, Pan XL, <italic>et al</italic>. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
27. 孙超, 陆世春, 王霄霖, 等. 三维重建技术在胸腔镜解剖性肺段切除术中的应用. 中国微创外科杂志, 2019, 19(2): 115-117.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical application of three-dimensional computed tomography bronchography and angiography in robotic lung segmentectomy

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