Three-dimensional virtual lung reconstruction in robotic segmentectomy: A safety and feasibility trial

Abstract

Objective: Robotic pulmonary segmental resection is a technically challenging procedure.Near-infrared fluorescence mapping with intravascular indocyanine green dye is a valuable adjunct; however, conversion to lobectomy still occurs in up to 40% of cases.We hypothesized that the incorporation of 3-dimensional virtual lung reconstruction would result in low rates of conversion from segmentectomy to lobectomy and increased confidence in the surgical plan.Methods: A prospective single-center cohort trial was conducted to determine the safety and feasibility of this approach.Patients undergoing robotic segmentectomy for clinical stage I non-small cell lung cancer less than 3 cm were enrolled, and 3-dimensional reconstruction was performed with confidence scores assigned before and after 3-dimensional reconstruction.Adverse events, rates of conversion to lobectomy, and changes in confidence scores were recorded and analyzed.Results: A total of 79 patients were enrolled from December 2022 to April 2024, and 76 patients (96.20%) underwent surgery.Three-dimensional reconstruction was successfully performed in 88.16% (67/76) of cases, and indocyanine green dye was used in 68.66% (46/67) with no adverse events related to its use.The 30-day mortality was 1.49% (1/59).The majority of patients (80.60%; 54/67) underwent a successful segmentectomy, whereas 8.96% (6/67) of cases were converted to lobectomy after segmentectomy was started.The planned operation was modified after 3-dimensional reconstruction in 36.07%(22/61) of cases leading to a significant increase in confidence scores (P < .001).Conclusions: Three-dimensional lung reconstruction in targeted robotic segmental resection is associated with low rates of conversion to lobectomy and increased surgeon confidence.Further studies are warranted to establish the effectiveness of this technique.(JTCVS Techniques 2025;29:150-60) 3D virtual lung model for planning of right S1 resection generated by Synapse 3D. CENTRAL MESSAGE3D virtual lung reconstruction in robotic segmentectomy is associated with a low rate of conversion to lobectomy and improved surgeon confidence. PERSPECTIVEThis study demonstrates that in patients undergoing robotic segmentectomy, 3D virtual lung reconstruction for preoperative planning is associated with low rates of conversion to lobectomy, a change in the target segment in more than onethird of cases, and increased confidence in the preoperative plan.Adoption of this approach may be beneficial.