Virtual navigation to guide personalized treatment of small-size lung cancer using minimally invasive techniques

Ouizimi and colleagues authors have developed a technique of anatomical segmentectomy and subsegmentectomy, performed by video-assisted thoracic surgery (VATS) and guided by contrast-enhanced three dimensional (3D) computed tomographic (CT) simulations (1). They describe a right anterior segmentectomy using the technique. The authors routinely use CT with angiography to produce detailed 3D images of segmental anatomy particularly blood vessels and bronchi. The images guide the resection using electrical devices and staplers, and in particular assist the isolation and division of blood vessels and bronchi. Even small subsegments can be resected with sufficient surgical margins. The authors place a slip-knot round the bronchus of the segment to be removed, inflate the target lung, tighten the knot and deflate the lung again, so that the target segment remains inflated, helping to identify the intersegmental plane.