Application Of 3D-CT Bronchography And Angiography In Robot-assisted Thoracoscopic Anatomical Segmentectomy

Objective:To explore the clinical value of 3D-CTBA in robot-assisted thoracoscopic(RATS)segmentectomy and evaluate the efficacy and accuracy of 3D-CTBA reconstruction in the identification of segment anatomical structure and variation during thoracoscopic segmentectomy.And we report the anatomical variations found.Methods:From October 2018 to October 2019,all patients with pulmonary nodules who underwent RATS segmentectomy were enrolled in this prospective comparative trial.And these patients were randomized to preoperative 3D reconstruction-guided robotic segmentectomy(3D reconstruction group)and conventional robotic segmentectomy(non-reconstructive group).We compared the perioperative clinical data of the two groups in the cohort.Results:A total of 55 patients were randomly assigned to undergo either 3D reconstruction group(30 patients)or non-reconstructive group(25patients).All patients of both groups underwent totally robotic operation without thoracotomy.The operative duration,intraoperative blood loss and Chest tube duration in 3D reconstruction group was significantly shorter than the non-reconstructive group(p <0.05).There was no significant difference in age,gender,nodule diameter,nodule location,the number of dissected lymph nodes,postoperative hospital stay,postoperative complications between the two groups(p >0.05).The accuracy of preoperative3D-CTBA model in identifying of target segmental arteries,veins and bronchi were99.3%(142/143),98.39%(122/124)and 100%(118/118)respectively.Through3D-CTBA model,Mediastinal and interlobar type of lingular segment arteries were found in 6 patients and central veins lack in 7 patients.In addition,2 patients were found with rare anatomical variation,one had the right apical segment bronchussolely stemming from right primary bronchus(tracheal bronchus),the others had rare right basal segment variant bronchi and vessels.Conclusions:3D-CTBA model can precisely show the anatomical structure variation of the segmental bronchi and vessels before operation,which can make robot-assisted thoracoscopic anatomical segmentectomy have better perioperative outcomes and significantly improve the accuracy and safety.At the same time,3D-CTBA is an effective way to analyze the anatomical structure in the lung.