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Publications

Journal Article Ppublish

PubMed: 41376970 DOI: 10.21037/jtd-2025-716

Evaluating non-contrast 3D reconstructions for pulmonary segmentectomy: a reliable alternative to contrast-enhanced models in thoracic surgery.

J Thorac Dis 17(11):9885-9894

Authors: ChloƩ Lafouasse, Rime Essid, Guillaume Boddaert, Agathe Seguin-Givelet

Affiliations

  • Department of Thoracic Surgery, Institut Mutualiste Montsouris, Paris, France.
  • Department of Thoracic Surgery, CHU of Caen Normandie, Caen, France.
  • Department of Thoracic Surgery, Ambroise ParĆ©-Hartmann Private Hospital Group, Neuilly-sur-Seine, France.

Abstract

BACKGROUND

Thoracoscopic segmentectomy is increasingly used to treat early-stage non-small cell lung cancer (NSCLC) due to its ability to preserve pulmonary function and maintain quality of life. Preoperative three-dimensional (3D) reconstructions are essential for planning this procedure, particularly for identifying anatomical variations and ensuring precise resections. While intravenous (contrast-enhanced) (IV) 3D models are the gold standard, they are associated with risks such as allergic reactions, renal impairment, and logistical challenges. The aim of this study was to evaluate whether non-intravenous (non-contrast imaging) (NIV) 3D models can provide an anatomically reliable alternative to IV-based models for preoperative planning in pulmonary segmentectomy.

METHODS

This mixed-designed study with prospective enrollment and retrospective data analysis evaluated the anatomical equivalence of NIV 3D models by Visible Patient compared to IV-based models in 24 patients scheduled for pulmonary segmentectomy. Postoperative analysis assessed concordance between the models and intraoperative findings, focusing on the impact of any discrepancies on surgical decision-making.

RESULTS

NIV models demonstrated an 83.3% concordance rate with IV models for major anatomical structures, including significant vascular and bronchial variations. Minor differences, primarily involving small intraparenchymal vessels, were observed in 16.7% of cases but had no impact on surgical strategy. Both models reliably identified complex variants, such as mediastinal lingular arteries, highlighting the clinical utility of NIV reconstructions.

CONCLUSIONS

NIV 3D models by Visible Patient offer a reliable alternative for preoperative planning, particularly in patients contraindicated for contrast agents. While IV models remain the gold standard, NIV models address critical challenges, including contrast-related risks and logistical inefficiencies, supporting their integration into routine thoracic surgical practice. Further multicenter validation is recommended.

MeSH

Thoracic Surgery, Carcinoma, Non-Small-Cell Lung, Mastectomy, Segmental