{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:34:03Z","timestamp":1753893243486,"version":"3.41.2"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,3,29]],"date-time":"2021-03-29T00:00:00Z","timestamp":1616976000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p><jats:bold>Objective:<\/jats:bold> Interactive three-dimensional virtual models of pulmonary structures (3D-CT) may improve the safety and accuracy of robotic-assisted thoracic surgery (RATS). The aim of this study was to evaluate the impact of 3D-CT models as an imaging adjunct on surgical confidence and anatomical assessment for lobectomy planning.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> We retrospectively analyzed the response of 10 specialist thoracic surgeons who each reviewed 10 pre-operative images of patients undergoing robotic-assisted lobectomy lung cancer cases from June to November 2018 in our institute, resulting in 100 data points. The number of arteries, veins, and bronchi entering the resected lobes were determined from the operation video recording by the operating surgeon. 3D-CT models were generated for each case and made available for online visualization and manipulation. Thoracic surgeons were invited to participate in the survey which consisted of evaluation of CT (control) and 3D-CT (intervention) models. A questionnaire regarding anatomical structures, surgical approach, and confidence was administered.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Ten participants were recruited. 3D-CT models led to a significant (<jats:italic>p<\/jats:italic> &amp;lt; 0.003) increase in the surgeons' ability to correctly identifying pulmonary arteries entering the resection lobes in 35% (CT) and 57% (3D-CT) of cases. A significant (<jats:italic>p<\/jats:italic> &amp;lt; 1e-13) improvement in anatomy assessment and surgical plan confidence was observed for the 3D-CT arm, with median Likert scale scores of \u201c2\u2013Slightly easy\u201d (CT) and \u201c4\u2013Very easy\u201d (3D-CT).<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> The use of 3D-CT models for thoracic surgery planning increases the surgeon confidence in recognizing anatomical structures, largely by enhanced appreciation of anatomical variations in the segmental pulmonary arterial system. Further studies are needed to investigate if 3D-CT models can be used in providing precise information about segmental artery distribution and therefore surgical planning of sub-lobar resections.<\/jats:p>","DOI":"10.3389\/fsurg.2021.652428","type":"journal-article","created":{"date-parts":[[2021,3,29]],"date-time":"2021-03-29T16:57:10Z","timestamp":1617037030000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Surgeon Knowledge of the Pulmonary Arterial System and Surgical Plan Confidence Is Improved by Interactive Virtual 3D-CT Models of Lung Cancer Patient Anatomies"],"prefix":"10.3389","volume":"8","author":[{"given":"Kunal","family":"Bhakhri","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eoin R.","family":"Hyde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sze M.","family":"Mak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenz U.","family":"Berger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastien","family":"Ourselin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Routledge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Bill\u00e8","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,3,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"4993","DOI":"10.1200\/JCO.2007.12.6649","article-title":"Video-assisted thoracic surgery lobectomy: report of CALGB 39802\u2014a prospective, multi-institution feasibility study","volume":"25","author":"Swanson","year":"2007","journal-title":"J Clin Oncol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1016\/j.athoracsur.2005.07.078","article-title":"Video-assisted thoracic surgery lobectomy: experience with 1,100 cases","volume":"81","author":"McKenna","year":"2006","journal-title":"Ann Thorac Surg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1016\/j.athoracsur.2016.03.032","article-title":"Comparison of video-assisted thoracoscopic surgery and robotic approaches for clinical stage I and stage II non-small cell lung cancer using the Society of Thoracic Surgeons database","volume":"102","author":"Louie","year":"2016","journal-title":"Ann Thorac Surg."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1733","DOI":"10.1016\/j.athoracsur.2017.06.020","article-title":"Robotic-assisted, video-assisted thoracoscopic and open lobectomy: propensity-matched analysis of recent premier data","volume":"104","author":"Oh","year":"2017","journal-title":"Ann Thorac Surg."},{"key":"B5","doi-asserted-by":"publisher","first-page":"23","DOI":"10.21037\/jovs.2018.01.04","article-title":"From RATS to VATS: why we did choose this way","volume":"4","author":"Schmid","year":"2018","journal-title":"J Visual Surg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"107","DOI":"10.21037\/jovs.2018.05.07","article-title":"From \u201copen\u201d to robotic assisted thoracic surgery: why RATS and not VATS?","volume":"4","author":"Ricciardi","year":"2018","journal-title":"J Visual Surg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"229","DOI":"10.21037\/jovs.2018.10.12","article-title":"Training program in robotic thoracic surgery","volume":"4","author":"Filho","year":"2018","journal-title":"J Visual Surg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1177\/1556984519826321","article-title":"Interactive 3D reconstruction of pulmonary anatomy for preoperative planning, virtual simulation, and intraoperative guiding in video-assisted thoracoscopic lung surgery","volume":"14","author":"Sardari Nia","year":"2019","journal-title":"Innovations."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40792-018-0445-0","article-title":"Composite resection of the left upper lobe and superior segment (S6) of the lower lobe for lung cancer with a mediastinal lingular and basal pulmonary artery","volume":"4","author":"Nakano","year":"2018","journal-title":"Surg Case Rep."},{"key":"B10","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1016\/S0003-4975(02)04375-8","article-title":"Use of three-dimensional computed tomographic angiography of pulmonary vessels for lung resections","volume":"75","author":"Watanabe","year":"2003","journal-title":"Ann Thorac Surg."},{"key":"B11","doi-asserted-by":"publisher","first-page":"3844","DOI":"10.12998\/wjcc.v7.i22.3844","article-title":"Thoracoscopic segmentectomy assisted by three-dimensional computed tomography bronchography and angiography for lung cancer in a patient living with situs inversus totalis: a case report","volume":"7","author":"Wu","year":"2019","journal-title":"World J Clin Cases."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5761\/atcs.ra.12.02174","article-title":"Three dimensional computed tomography lung modeling is useful in simulation and navigation of lung cancer surgery","volume":"19","author":"Ikeda","year":"2013","journal-title":"Ann Thorac Cardiovasc Surg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1016\/j.jtcvs.2015.06.051","article-title":"Preoperative (3-dimensional) computed tomography lung reconstruction before anatomic segmentectomy or lobectomy for stage I non\u2013small cell lung cancer","volume":"150","author":"Chan","year":"2015","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B14","doi-asserted-by":"publisher","first-page":"526","DOI":"10.21037\/atm.2019.09.135","article-title":"Preoperative 3D-CT bronchography and angiography facilitates single-direction uniportal thoracoscopic anatomic lobectomy","volume":"7","author":"Zhang","year":"2019","journal-title":"Ann Transl Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"201","DOI":"10.21037\/cdt.2018.01.04","article-title":"Pulmonary vascular anatomy & anatomical variants","volume":"8","author":"Kandathil","year":"2018","journal-title":"Cardiovasc Diagn Ther."},{"key":"B16","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1093\/icvts\/ivt120","article-title":"Virtual segmentectomy based on high-quality three-dimensional lung modelling from computed tomography images","volume":"17","author":"Saji","year":"2013","journal-title":"Interact Cardiovasc Thorac Surg."},{"key":"B17","doi-asserted-by":"publisher","first-page":"S1222","DOI":"10.21037\/jtd.2018.02.88","article-title":"Determination of the intersegmental plane using the slip-knot method","volume":"10","author":"Endoh","year":"2018","journal-title":"J Thorac Dis."},{"key":"B18","doi-asserted-by":"publisher","first-page":"2343","DOI":"10.21037\/jtd.2020.03.83","article-title":"The arterial-ligation-alone method for identifying the intersegmental plane during thoracoscopic anatomic segmentectomy","volume":"12","author":"Fu","year":"2020","journal-title":"J Thorac Dis."},{"key":"B19","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1016\/j.xjtc.2020.05.001","article-title":"Constant-rate intravenous infusion of indocyanine green leading to high fluorescence intensity in infrared thoracoscopic segmentectomy","volume":"3","author":"Misaki","year":"2020","journal-title":"JTCVS Tech"},{"key":"B20","doi-asserted-by":"publisher","first-page":"6598","DOI":"10.21037\/jtd.2018.10.126","article-title":"Preoperative 3-dimensional computed tomography lung simulation before video-assisted thoracoscopic anatomic segmentectomy for ground glass opacity in lung","volume":"10","author":"Xue","year":"2018","journal-title":"J Thorac Dis."},{"key":"B21","doi-asserted-by":"publisher","first-page":"274","DOI":"10.21037\/acs.2019.03.02","article-title":"Disruptive technology will transform what we think of as robotic surgery in under ten years","volume":"8","author":"Dunning","year":"2019","journal-title":"Ann Cardiothorac Surg."},{"key":"B22","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1111\/1759-7714.12241","article-title":"Analysis of lymph node impact on conversion of complete thoracoscopic lobectomy to open thoracotomy","volume":"6","author":"Li","year":"2015","journal-title":"Thorac Cancer."},{"key":"B23","doi-asserted-by":"publisher","first-page":"4362","DOI":"10.1118\/1.4954009","article-title":"Mediastinal lymph node detection and station mapping on chest CT using spatial priors and random forest","volume":"43","author":"Liu","year":"2016","journal-title":"Med Phys."},{"key":"B24","doi-asserted-by":"publisher","first-page":"171","DOI":"10.21037\/jovs.2016.10.04","article-title":"Thoracoscopic anatomic segmentectomies for lung cancer: technical aspects","volume":"2","author":"Gossot","year":"2016","journal-title":"J Visual Surg."}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2021.652428\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,29]],"date-time":"2021-03-29T16:57:13Z","timestamp":1617037033000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2021.652428\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,29]]},"references-count":24,"alternative-id":["10.3389\/fsurg.2021.652428"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2021.652428","relation":{},"ISSN":["2296-875X"],"issn-type":[{"type":"electronic","value":"2296-875X"}],"subject":[],"published":{"date-parts":[[2021,3,29]]},"article-number":"652428"}}