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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18.	張磊, 謝冬, 陳昶. 肺磨玻璃結節術中定位方法的應用進展. 中國胸心血管外科臨床雜志, 2018, 25(12): 1080-1084.
19.	宋鐵牛, 李斌, 夏學陽, 等. 醫用膠在肺微小結節術前定位中的應用. 中國胸心血管外科臨床雜志, 2018, 25(4): 354-356.
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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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27.	孫超, 陸世春, 王霄霖, 等. 三維重建技術在胸腔鏡解剖性肺段切除術中的應用. 中國微創外科雜志, 2019, 19(2): 115-117.

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin, 2020, 70(1): 7-30.
2. 周清華, 范亞光, 王穎, 等. 中國肺部結節分類、診斷與治療指南(2016 年版). 中國肺癌雜志, 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, 蔣偉, 王琳, 等. 肺部磨玻璃結節的處理原則和共識及手術技巧. 中華腫瘤雜志, 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, 胡堅, 劉倫旭, 等. 人工智能平臺下肺結節的三維可視化定位與手術規劃專家共識. 中國胸心血管外科臨床雜志, 2019, 26(12): 1161-1166.
10. 陶紹霖, 康珀銘, 譚群友, 等. 經前側入路達芬奇機器人輔助肺段切除術的臨床分析. 中國胸心血管外科臨床雜志, 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. 陳亮, 王俊, 吳衛兵, 等. 胸腔鏡精準肺段切除術技術流程和質量控制. 中國胸心血管外科臨床雜志, 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. 初向陽, 侯曉彬, 張連斌, 等. CT引導下 Hook-wire 定位肺磨玻璃樣微小結節微創切除的臨床研究. 中國肺癌雜志, 2014, 17(12): 845-849.
15. 姜格寧, 陳昶, 朱余明, 等. 上海市肺科醫院磨玻璃結節早期肺腺癌的診療共識(第一版). 中國肺癌雜志, 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. 張磊, 謝冬, 陳昶. 肺磨玻璃結節術中定位方法的應用進展. 中國胸心血管外科臨床雜志, 2018, 25(12): 1080-1084.
19. 宋鐵牛, 李斌, 夏學陽, 等. 醫用膠在肺微小結節術前定位中的應用. 中國胸心血管外科臨床雜志, 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, 林吉興, 等. 肺小結節胸腔鏡手術術前定位方法研究進展. 武警醫學, 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. 孫超, 陸世春, 王霄霖, 等. 三維重建技術在胸腔鏡解剖性肺段切除術中的應用. 中國微創外科雜志, 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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