Abstract
ObjectiveRobotic pulmonary segmental resection is a technically challenging procedure. Near-infrared fluorescence (NIF)-mapping with intravascular indocyanine green dye (ICG) is a valuable adjunct, however conversion to lobectomy still occurs in up to 40% of cases. We hypothesized that the incorporation of 3D virtual lung reconstruction would result in low rates of conversion from segmentectomy to lobectomy, and increased confidence in the surgical plan. MethodsA prospective single-centre cohort trial was conducted to determine the safety and feasibility of this approach. Patients undergoing robotic segmentectomy for clinical stage I NSCLC <3 cm were enrolled and 3D reconstruction was performed with confidence scores assigned before and after 3D reconstruction. Adverse events, rates of conversion to lobectomy, and changes in confidence scores were recorded and analysed. Results79 patients were enrolled from December 2022 to April 2024 and 76(96.20%) patients underwent surgery. 3D reconstruction was successfully performed in 88.16%(67/76) of cases and ICG was used in 68.66%(46/67) with no adverse events related to its use. 30-day mortality was 1.49%(1/59). The majority of patients (80.60%;54/67) underwent a successful segmentectomy, while 8.96%(6/67) of cases were converted to lobectomy after segmentectomy was started. The planned operation was modified after 3D reconstruction in 36.07%(22/61) of cases leading to a significant increase in confidence scores (p<0.001). Conclusion3D 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.
Published Version
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