Virtual Navigation Technology for the Functional Restoration of Anastomosis in Oncologic Pulmonary Surgery

Q4 Medicine

Open Respiratory Archives Pub Date : 2025-09-03 DOI:10.1016/j.opresp.2025.100482

Pedro Juan Rodríguez Martín, Laura Martínez Vega, Felipe Cristóbal Andreo García

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Abstract

A 44-year-old woman, former smoker, underwent apical segmentectomy of the right lower lobe in 2015 for a typical carcinoid tumor (1.5 cm, Ki 67 < 2%, T1aN0M0R1). In 2024, follow-up CT revealed a suspicious lesion, and PET scan confirmed a 13 mm nodule (SUVmax 6). In January 2025, she had an extended right lower lobectomy with bronchoplasty. Weeks later, flexible bronchoscopy showed reduced bronchial lumen, partially visualizing the middle lobe bronchi (ML). Two months post-surgery, due to increasing dyspnea, an almost complete distal stenosis of the intermediate bronchus was discovered, preventing access to the ML. After unsuccessful balloon dilation and anatomical uncertainty, the procedure was stopped. CT with 3D reconstruction (Fujifilm Synapse 3D software) and virtual bronchoscopy navigation (VBN) was performed with this planner. Guided by VBN, biopsies and successful balloon dilation reopened the ML bronchial orifice. The case highlights the value of VBN and 3D reconstruction for planning and guiding complex endoscopic procedures.

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虚拟导航技术在肿瘤肺外科吻合功能恢复中的应用

一名44岁女性，前吸烟者，因典型的类癌（1.5 cm, Ki 67 < 2%, T1aN0M0R1）于2015年行右下叶根尖段切除术。2024年随访CT显示可疑病变，PET扫描确认13mm结节（SUVmax 6）。2025年1月，她接受了扩大右下肺叶切除术和支气管成形术。几周后，支气管镜检查显示支气管管腔缩小，支气管中叶部分可见。术后2个月，由于呼吸困难加重，发现中间支气管远端几乎完全狭窄，无法进入ML。由于球囊扩张失败和解剖结构不确定，手术停止。使用该计划仪进行CT三维重建（Fujifilm Synapse 3D软件）和虚拟支气管镜导航（VBN）。在VBN引导下，活检和成功的球囊扩张使ML支气管口重新开放。该病例强调了VBN和3D重建在规划和指导复杂内窥镜手术中的价值。

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