Three-Dimensional Computed Tomography Reconstruction in Uniportal Thoracoscopic Segmentectomy: A Propensity Score-matched Analysis

Abstract

Objectives

Given the complexity of vascular and bronchial variations during segmental resection, three-dimensional (3D) reconstruction has been proposed as an effective tool to address anatomical challenges in segmentectomy. This study aims to evaluate the utility of 3D reconstruction in enhancing anatomical comprehension, optimizing surgical planning, and improving perioperative outcomes.

Methods

From December 2022 to March 2024, clinical data of 141 patients who underwent uniportal thoracoscopic pulmonary segmentectomy were gathered. Based on preoperative examinations, the patients were categorized into the 3D group (51 patients) and the non - 3D group (90 patients). Primary endpoints were resection margin (distance from staple line to tumor) and operative time; secondary endpoints included intraoperative blood loss, conversion to thoracotomy, postoperative complications, and hospital stay. Propensity score matching was carried out to mitigate selection bias between the two groups.

Results

After 1:1 propensity score matching, 51 patients were included in each group. The operation time in the 3D group was shorter than that in the non-3D group (P = 0.004). The 3D group had significantly less blood loss compared to the non-3D group (P = 0.004). No significant differences were observed between the groups regarding resection margins, harvested lymph nodes, postoperative drainage, hospital stay, and postoperative complications.

Conclusions

3D reconstruction enhances anatomical understanding, shortens operative time, reduces blood loss, and facilitates surgical plan adjustments, while ensuring adequate resection margins in uniportal thoracoscopic segmentectomy.