The Application And Research Of Three-dimensional Image Reconstrction Software "Exoview" In Anatomical Segmentectomy

Part 1:Preoperative evaluation of the segmental artery by three-dimensional image reconstruction software "Exoview" vs.thin-section multi-detector computed tomography.Aim:The aim of this retrospective study was to compare the using of a new three-dimensional(3D)image reconstruction software which was developed by our medical team independently(Exoview)and another 3D image reconstruction software(Mimics)with thin-section multi-detector computed tomography(MDCT),in the preoperative evaluation of segmental artery(SA).Methods:From May 2018 to March 2020,104 patients received anatomical segmentectomy in our department.According to intraoperative findings of the SA branches,we compared the ability of detecting SA between 3D images that reconstructed by two 3D image reconstruction software(Exoview and Mimics)and thin-section MDCT.In addition,for evaluate the image reconstruction efficiency of two software,a thoracic surgeon who has rich experience in each software(>30 cases)would be timed when he used each software to reconstruct pulmonary vessel and bronchus.The collected data include patient's characterizes,reconstruction time,operative factors and the branching patterns of the pulmonary artery of the targeted lung segments according to the intraoperative findings,3D image reconstruction,and CT images.Results:There were 12 patients accepted VATS lobectomy with radical lymph nodes dissection because invasive adenocarcinoma was affirmed by intraoperative frozen-section analysis and 1 conversion from VATS segmentectomy to an open operation because of the bleeding of segmental artery.According to intraoperative findings,100%(274 of 274)of these SA branches were precisely identified on thin-section MDCT images.3D images reconstructed by Exoview identified 94.5%(259 of 274)SA branches and fifteen missed branches were less than 1.5mm in actual diameter;3D images reconstructed by Mimics identified 96,0%(263 of 274)SA branches and eleven missed branches were less than 1.4mm in actual diameter.The reconstruction time had a significant difference between Exoview and Mimics(28.95± 14.71 vs.33.22± 14.77 min,P=0.038)Conclusion:Exoview has a higher image reconstruction efficiency than Mimics.3D image reconstruction software "Exoview" could visualize SA for surgeon and be a great help to evaluation for SA before segmentectomy.However,the thin-section MDCT provided a better evaluation of small SA branches.Part 2:The research of segmentectomy under the guidance of three-dimensional image reconstruction software "Exoview"Aim:The aim of this retrospective study was to research the video-assisted thoracoscope segmentectomy that guided by three-dimensional image reconstruction software "Exoview".Methods:Between July 2018 to April 2020,99 patients received video-assisted thoracoscopic segmentectomies that guided by 3D image reconstruction software "Exoview"in our department were enrolled.Patients were grouped according to the method of intersegmental plane identification they accepted.37 patients accepted modified inflation-deflation method and 42 patients accepted indocyanine green method for intersegmental plane identification.In addtion,another 20 patients accepted both methods to identify the intersegmental plane,in order to evaluate whether the intersegmental plane revealed by the two methods were concordant.The data collected in the trial included patient characteristics,branching patterns of segmental artery,operation time,blood loss,times of indocyanine green injection,length of stay,stations of lymph node sampling,postoperative lung function,drainage,extubation days,pain score and postoperative complication.Results:With the guide of Exoview 3D images,all patients accepted segmentectomies under video-assisted thoracoscope.The characteristics of patients between two methods were similar.Indocyanine green method had a less operation time than inflation-deflation method(122.52± 15.43 vs.137.68±18.75 min,P<0.01).There was no significant difference between the two methods in terms of blood loss(55.81±21.91 vs.53.81 ±22.30 ml,P=0.689),length of stay(5.32±1.96 vs.5.14±1.84 days,P=0.673),extubation days(4.19±1.90 vs.4.10±1.56 days,P=0.810),lymph node sampling(4.08± 1.61 vs.4.05± 1.48 stations,P=0.923),drainage(552.03±144.18 vs.562.02±184.26ml,P=0.791),pain score(3.81±1.73 vs.3.14± 1.69,P=0.087),postoperative FEV1%(76.70± 10.82 vs.79.50±10.72,P=0.253)and postoperative FEV1(2.24±0.50 vs.2.24±0.43 L,P=0.961).No metastasis was detected in the sampled lymph nodes.Pathological types included adenocarcinoma in situ with microinvasion(17 case in inflation-deflation method,21 case in indocyanine green method),lepidic predominant adenocarcinoma(10 case in inflation-deflation method,8 case in indocyanine green method),adenocarcinoma in situ(9 case in inflation-deflation method,11 case in indocyanine green method)and atypical adenomatous hyperplasia(1 case in inflation-deflation method,2 case in indocyanine green method).The postoperative complications include allergy(1 case in indocyanine green method),prolong air-leakage(1 case in inflation-deflation method,lcase in indocyanine green method)and pulmonary infection(1 case in indocyanine green method).1 case because of poor coloration and 4 cases because of rapid discoloration accepted twice injection.Among the 20 patients accepted both methods,both methods revealed the intersegmental plane clearly and the results were concordant.Postoperative complications included air-leakage and pulmonary infection.Conclusion:Under the guidance of 3D image reconstruction software "Exoview",surgeons can do a sufficient evaluation of pulmonary anatomy before operation and make the operation safer.The intersegmental planes that revealed by modified inflation-deflation method and indocyanine green method were concordant.However,indocyanine green method could reduce the operation time compared with modified inflation-deflation method and the incidence of postoperative complications was not increased.