The Role of Advanced Imagine and 3D reconstruction in Robotic Thoracic Surgery for challenging cases.

 

 

Objective: In the last years, 3D anatomical model, based on the CT images, allows surgeons to better determine the anatomical relationships between tumor and hilar structures and plays  a crucial role in pre-operative surgical planning.

The use of this technology can be useful to well define and plan the appropriate surgical procedure in challenging cases, using robotic platforms.

 

Methods: A sample of three challenging cases in thoracic surgery were selected. All patients have been evaluated with a preoperative CT scan and a 3D reconstruction was performed, using“3D Slicer image computing platform” software, which is a free, open source and multi-platform software package widely used for medical, biomedical, and related imaging research.

After the 3D reconstruction, a specific surgical strategy for each case was planned and all the surgical procedures were performed using a fully four-arm Robotic approach.

 

Results: Case 1: patient diagnosed with NSCLC of the right upper lobe suspected to infiltrate the thoracic wall, who underwent neoadjuvant chemo-radiotherapy The 3D  reconstruction  has allowed to define the anatomical relationship between the tumor and the Chest Wall and to perform a lobectomy with Robotic technique. Case 2: :NSCLC of Right Lung strictly adherent  to hilar structures with a suspected infiltration of lower right artery; the reconstruction showed the anatomical relationship between the cancer and the hilar structures and a  totally Robotic lower bilobectomy was performed.Case 3:Thymic carcinoma of 8,5 cm of diameter close to the aortic arch with a compression of the main trunk of the pulmonary artery. The 3D reconstruction allowed to plan the procedure  so as to perform a complete thymectomy with Robotic approach.

 

Conclusion: The application of 3D reconstruction before the surgical approach of complex cases   allowed to approach that cases with the Robotic surgery in a safe and feasible way.