In-house patient-specific preoperative three-dimensional visualisation for anatomical lung resections

Introduction
For patients with local non-small cell lung cancer <2cm with poor pulmonary function, a segmentectomy might be considered as a treatment option. However, a segmentectomy is a complex and low-volume procedure. Using three-dimensional (3D) models is proven to be of added value for these procedures and can potentially decrease intraoperative blood loss, operative time and patient complications. Commercial services are costly and require transfer of sensitive patient data to external entities.
This study aims to facilitate pre-operative planning of segmentectomies using 3D models produced with an in-house segmentation protocol compared to standard 2D contrast-enhanced CT scans.
Methods and results
14 patients with stage 1A1-2 NSCLC who underwent a segmentectomy from 2023 to August 2024 were included in the study. An in-house CT-scan segmentation protocol was developed using Mimics software and compared to 3D Slicer segmentation. Informed consent was obtained after local ethics approval. Additionally, surgeons retrospectively filled in questionnaires to estimate changes in the surgical plan. Moreover, each 3D model was given an quality score. Questionnaires revealed that surgeons felt comfortable creating a preoperative plan using 3D models (96%). Quality was perceived as good or excellent in all but one case. The use of 3D models changed 32% of all surgical plans compared to 2D CT. For patients prospectively planned with our 3D models, all relevant structures were correctly identified, and confirmed during surgery.
Conclusions
In all cases, preoperative 3D models showed to have added value in increasing the understanding of patientspecific anatomy, and should be validated externally.