Planning thoracoscopic segmentectomies with three-dimensional-reconstruction software improves outcomes.

Objectives: In this study, we investigated whether preoperative reconstructions of the lung anatomy using 3D-reconstruction (3D) software based on HRCT-scans improve surgical and postoperative outcomes after video-assisted thoracoscopic (VATS) segmentectomies.

Methods: We retrospectively collected data from 100 consecutive patients who signed the general research consent form and underwent VATS-segmentectomies between 2018 and 2023. The outcomes and complications of the surgeries planned with 3D were compared to the results of those performed without. We used propensity modelling and inverse probability of treatment weighting (IPTW) to analyse the data.

Results: Thirty-seven of the 100 patients included underwent surgery planned with 3D. In the 3D group, complex segmentectomies were more frequent (89% vs 38%, P < 0.001), there were markedly fewer conversions to thoracotomy (P = 0.003). The IPT-weighted analysis showed fewer severe complications Clavien-Dindo grade III or IV, post-IPTW odds ratio 0.10 (95% CI 0.01 to 0.87), P = 0.037, no complication Clavien-Dindo grade V occurred.Additionally, surgery planning using 3D may influence procedural and postoperative parameters, such as the number of segments removed (1.9 ± 1.0 vs 1.7 ± 0.8, P = 0.40), duration of the chest tube placement (3.0 days, IQR 2.0-4.0 vs 2.0 days, IQR 1.0-3.0, P = 0.060), and stay in the intensive/intermediate care unit.

Conclusions: The planning of complex anatomical VATS-segmentectomies with 3D significantly reduces the need for conversions to thoracotomy and postoperative complications rates. In addition, complex surgeries are thereby performed safely.