Three-dimensional computed tomography bronchography and angiography in the preoperative evaluation of thoracoscopic segmentectomy and subsegmentectomy

Thoracoscopic pulmonary segmentectomy is technically meticulous due to the complicated anatomical variations of segmental bronchus and vessels. Currently three dimensional-computed tomography angiography (3D-CTA) could only meet the simple requirements of segmentectomy. Our center developed a software for reconstruction, "deepinsight", which could effectively solve some key technical problems. Preoperative three-dimensional computed tomography bronchography and angiography (3D-CTBA) could reveal the anatomical structures and improve the accuracy of operation. Preoperative simulation on the three-dimensional image is helpful for surgery planning, which includes nodule location, identification of the targeted vessels, bronchus and surgical margin, revealing of anatomical variations, and planning of surgical approach. With the assistance of 3D navigation, during the surgical procedure all the targeted structures could be divided accurately, the intersegmental veins could be preserved, the targeted parenchyma could be en bloc removed, and the surgical margin could be ensured. Our center has developed a method to separate pulmonary segments from the lobe based on cone-shaped principle, and we named it "Cone-shaped Segmentectomy". This technique covers precise identification and dissection of segmental bronchus, vessels and intersegmental demarcation, which ultimately achieve a completely anatomical segmentectomy.