The well-matched interaction between virtuality and reality for intraoperative localization of nonpalpable pulmonary nodules

Abstract

The intraoperative localization of nonpalpable pulmonary nodules for thoracoscopic wedge resection is technically challenging. Current preoperative image-guided localization techniques require additional time, costs, procedural risks, advanced facilities, and well-trained operators. In this study, we explored a cost-effective method of well-matched interaction between virtuality and reality for accurate intraoperative localization. Through the integration of techniques involving preoperative 3-dimensional (3D) reconstruction, temporary clamping of target vessel and the modified inflation-deflation method, the segment on the 3D virtual model and the segment under the thoracoscopic monitor were well matched in the inflated state. Then the spatial relationships of target nodule to the virtual segment could be applied to the actual segment. The well-matched interaction between virtuality and reality would facilitate nodule localization. A total of 53 nodules were successfully localized. The median maximum diameter of the nodules was 9.0mm (interquartile range [IQR], 7.0-12.5mm). The median depthmin and depthmax were 10.0mm and 18.2mm, respectively. The median macroscopic resection margin was 16mm (IQR, 7.0-12.5mm). The median duration of chest tube drainage was 27hours, with a median total drainage of 170mL. The median postoperative length of hospital stay was 2days. The well-matched interaction between virtuality and reality is safe and feasible for intraoperative localization of nonpalpable pulmonary nodules. It may be proposed as a preferred alternative to traditional localization methods.