The utility and feasibility of three-dimensional reconstruction in surgical planning for multiple pulmonary nodules: a prospective self-controlled study.

Background: Three-dimensional (3D) is a useful tool for visualizing computed tomography (CT) scans, facilitating a clearer understanding of the spatial relationships between pulmonary lesions and the branching architecture of the bronchi and blood vessels. Several studies have demonstrated the benefit of preoperative 3D reconstruction in terms of intraoperative safety and short-term surgical outcomes after thoracoscopic surgery. However, evidence regarding the impact of 3D reconstruction on surgical planning of anatomical partial lobectomy (APL) is still lacking. This study aimed to evaluate the effect of 3D reconstruction in surgical planning and decision making compared with conventional clinical imaging.

Methods: This prospective self-controlled study included 49 patients with multiple lung nodules (MLNs). A 3D reconstruction model was created using thin-slice CT images with Mimics 21.0 software. Two novice surgeons and two experienced surgeons respectively conducted surgical planning based on the CT images and 3D reconstruction sequentially. The surgical plans based on the CT images and 3D reconstruction were compared with those after the evaluation of intraoperative inspection.

Results: Among the 49 participants enrolled to undergo sublobar resection (the patient level), 3D reconstruction significantly increased the surgical planning success rates both in novice surgeons (Surgeon A: 40.8% to 87.8%; Surgeon B: 49.0% to 89.8%) and experienced surgeons (Surgeon C: 83.7% to 100%; Surgeon D: 75.5% to 95.9%). For the entire 101 pulmonary nodules determined suitable for APL (the nodule level), all surgeons had higher surgical planning success rates with the help of 3D reconstruction and all success rates were above 90%. The gap in surgical planning success rates between novice surgeons and senior surgeons was closed. All patients were operated without intraoperative accident and without major postoperative complications.

Conclusions: The surgical planning success rates of both novice surgeons and experienced surgeons were significantly increased with the help of 3D reconstruction and reached a high level. 3D reconstruction also closed the gap of surgical planning between novice surgeons and experienced surgeons at patient level.