Developing a virtual reality simulation system for preoperative planning of thoracoscopic thoracic surgery

Perspectives on lung visualization: Three-dimensional anatomical modeling of computed and micro-computed tomographic data in comparative evolutionary morphology and medicine with applications for COVID-19

The vertebrate respiratory system is challenging to study. The complex relationship between the lungs and adjacent tissues, the vast structural diversity of the respiratory system both within individuals and between taxa, its mobility (or immobility) and distensibility, and the difficulty of quantifying and visualizing functionally important internal negative spaces have all impeded descriptive, functional, and comparative research. As a result, there is a relative paucity of three-dimensional anatomical information on this organ system in all vertebrate groups (including humans) relative to other regions of the body. We present some of the challenges associated with evaluating and visualizing the vertebrate respiratory system using computed and micro-computed tomography and its subsequent digital segmentation. We discuss common mistakes to avoid when imaging deceased and live specimens and various methods for merging manual and threshold-based segmentation approaches to visualize pulmonary tissues across a broad range of vertebrate taxa, with a particular focus on sauropsids (reptiles and birds). We also address some of the recent work in comparative evolutionary morphology and medicine that have used these techniques to visualize respiratory tissues. Finally, we provide a clinical study on COVID-19 in humans in which we apply modeling methods to visualize and quantify pulmonary infection in the lungs of human patients.

Enhancing three-dimensional anatomical understanding in complex thoracic surgery: a comparative study of OpVerse and Synapse 3D

OBJECTIVES

Virtual reality (VR) technology is increasingly employed in medical settings to provide innovative solutions for complex surgeries. In this study, we introduced and compared OpVerse, a multifunctional new VR platform developed for surgical simulations, with established software Synapse 3D to assess its efficacy in facilitating complex thoracic surgeries.

METHODS

Patient-specific VR digital twin thoracic models were created based on computed tomography scans of 9 patients with large thoracic neoplasms and 4 requiring tracheobronchial reconstruction. Twelve doctors as system testers were enlisted to evaluate the usability and user acceptance of OpVerse and Synapse 3D using the System Usability Scale (SUS) and the Technology Acceptance Model; they provided qualitative feedback through interviews.

RESULTS

OpVerse achieved higher scores than Synapse 3D in SUS (73.3 ± 14.6 vs 53.8 ± 11.6, P = 0.0006), as well as perceived usefulness (4.5 ± 0.4 vs 4.1 ± 0.5, P = 0.0134), perceived ease of use (4.2 ± 0.4 vs 3.8 ± 0.6, P = 0.0364) and attitude towards using and behavioural intention to use (4.6 ± 0.4 vs 3.6 ± 0.7, P = 0.0002) in Technology Acceptance Model, compared to Synapse 3D, indicating enhanced efficiency and user engagement with the new system. Participants favoured OpVerse for its immersive qualities, intuitive interface (particularly rotation and enhanced visual transparency effects) and ability to enhance comprehension of complex 3D anatomical structures.

CONCLUSIONS

OpVerse, our streaming VR simulation platform, enables the manipulation and visualization of patient-specific digital twin thoracic models through features such as rotation, enhanced visual transparency effects and measurement. Preliminary results suggest that OpVerse may offer advantages in terms of immersion, ease of use and understanding of 3D anatomical structures compared to Synapse 3D.

Virtual reality-based preoperative planning for optimized trocar placement in thoracic surgery: A preliminary study

Video-assisted thoracic surgery (VATS) is a minimally invasive approach for treating early-stage non-small-cell lung cancer. Optimal trocar placement during VATS ensures comprehensive access to the thoracic cavity, provides a panoramic endoscopic view, and prevents instrument crowding. While established principles such as the Baseball Diamond Principle (BDP) and Triangle Target Principle (TTP) exist, surgeons mainly rely on experience and patient-specific anatomy for trocar placement, potentially leading to sub-optimal surgical plans that increase operative time and fatigue. To address this, the authors present the first virtual reality (VR)-based pre-operative planning tool with tailored data visualization and interaction designs for efficient and optimal VATS trocar placement, following the established surgical principles and consultation with an experienced surgeon. In the preliminary study, the system's application in right upper lung lobectomy is demonstrated, a common thoracic procedure typically using three trocars. A preliminary user study of the system indicates it is efficient, robust, and user-friendly for planning optimal trocar placement, with a great promise for clinical application while offering potentially valuable insights for the development of other surgical VR systems.

Knee Arthroscopy in the Era of Precision Medicine: A Comprehensive Review of Tailored Approaches and Emerging Technologies

Knee arthroscopy, a minimally invasive procedure, has transformed the treatment of knee pathologies by enabling direct visualization and management with minimal tissue disruption. Recent advances in precision medicine have introduced a new dimension to this field, allowing for highly individualized surgical approaches considering each patient's unique genetic, environmental, and biomechanical characteristics. This review explores the integration of precision medicine into knee arthroscopy, focusing on tailored approaches and emerging technologies. Key innovations such as robotic-assisted surgery, advanced imaging, and patient-specific instrumentation have enhanced surgical accuracy and patient outcomes, reduced recovery times, and minimized postoperative complications. The review also examines the role of biomarkers in guiding personalized treatment strategies, including ligament reconstructions, meniscal repairs, and cartilage restoration, which are now being refined to cater to the specific needs of individual patients. While the benefits of these innovations are clear, there are challenges to widespread adoption, including cost, resource allocation, and the need for further research to validate the efficacy of precision-driven approaches in knee arthroscopy. Moreover, the ethical considerations surrounding personalized medicine, such as patient privacy and genetic data usage, must also be addressed. Despite these barriers, the future of knee arthroscopy in the era of precision medicine holds great promise, with ongoing developments in artificial intelligence, genomics, and biomarker discovery poised to further refine patient-centered care. This comprehensive review provides valuable insights into how precision medicine reshapes knee arthroscopy, offering a glimpse into the future of more targeted and effective orthopedic interventions. By embracing these advancements, surgeons and healthcare providers can ensure optimal outcomes for patients undergoing knee arthroscopy.

Revolutionizing thoracic surgery education: a bibliometric analysis of the past decade's literature

OBJECTIVES

Thoracic surgery is a complex field requiring advanced technical skills and critical decision-making. Surgical education must evolve to equip trainees with proficiency in new techniques and technologies.

METHODS

This bibliometric analysis systematically reviewed 113 articles on thoracic surgery skills training published over the past decade, retrieved from databases including Web of Science. Publication trends, citation analysis, author and journal productivity, and keyword frequencies were evaluated.

RESULTS

The United States contributed the most publications, led by pioneering institutions. Simulation training progressed from basic to sophisticated modalities and virtual reality emerged with transformative potential. Minimally invasive techniques posed unique learning challenges requiring integrated curricula.

CONCLUSION

Ongoing investments in educational research and curriculum innovations are imperative to advance thoracic surgery training through multidisciplinary strategies. This study provides an evidentiary foundation to optimize training and address the complexities of modern thoracic surgery.

Evolution of Three-Dimensional Computed Tomography Imaging in Thoracic Surgery

Radiologic reconstruction technology allows the wide use of three-dimensional (3D) computed tomography (CT) images in thoracic surgery. A minimally invasive surgery has become one of the standard therapies in thoracic surgery, and therefore, the need for preoperative and intraoperative simulations has increased. Three-dimensional CT images have been extensively used, and various types of software have been developed to reconstruct 3D-CT images for surgical simulation worldwide. Several software types have been commercialized and widely used by not only radiologists and technicians, but also thoracic surgeons. Three-dimensional CT images are helpful surgical guides; however, in almost all cases, they provide only static images, different from the intraoperative views. Lungs are soft and variable organs that can easily change shape by intraoperative inflation/deflation and surgical procedures. To address this issue, we have developed a novel software called the Resection Process Map (RPM), which creates variable virtual 3D images. Herein, we introduce the RPM and its development by tracking the history of 3D CT imaging in thoracic surgery. The RPM could help develop a real-time and accurate surgical navigation system for thoracic surgery.

Evaluating the use of three-dimensional reconstruction visualization technology for precise laparoscopic resection in gastroesophageal junction cancer

BACKGROUND

Laparoscopic gastrectomy for esophagogastric junction (EGJ) carcinoma enables the removal of the carcinoma at the junction between the stomach and esophagus while preserving the gastric function, thereby providing patients with better treatment outcomes and quality of life. Nonetheless, this surgical technique also presents some challenges and limitations. Therefore, three-dimensional reconstruction visualization technology (3D RVT) has been introduced into the procedure, providing doctors with more comprehensive and intuitive anatomical information that helps with surgical planning, navigation, and outcome evaluation.

AIM

To discuss the application and advantages of 3D RVT in precise laparoscopic resection of EGJ carcinomas.

METHODS

Data were obtained from the electronic or paper-based medical records at The First Affiliated Hospital of Hebei North University from January 2020 to June 2022. A total of 120 patients diagnosed with EGJ carcinoma were included in the study. Of these, 68 underwent laparoscopic resection after computed tomography (CT)-enhanced scanning and were categorized into the 2D group, whereas 52 underwent laparoscopic resection after CT-enhanced scanning and 3D RVT and were categorized into the 3D group. This study had two outcome measures: the deviation between tumor-related factors (such as maximum tumor diameter and infiltration length) in 3D RVT and clinical reality, and surgical outcome indicators (such as operative time, intraoperative blood loss, number of lymph node dissections, R0 resection rate, postoperative hospital stay, postoperative gas discharge time, drainage tube removal time, and related complications) between the 2D and 3D groups.

RESULTS

Among patients included in the 3D group, 27 had a maximum tumor diameter of less than 3 cm, whereas 25 had a diameter of 3 cm or more. In actual surgical observations, 24 had a diameter of less than 3 cm, whereas 28 had a diameter of 3 cm or more. The findings were consistent between the two methods (χ2 = 0.346, P = 0.556), with a kappa consistency coefficient of 0.808. With respect to infiltration length, in the 3D group, 23 patients had a length of less than 5 cm, whereas 29 had a length of 5 cm or more. In actual surgical observations, 20 cases had a length of less than 5 cm, whereas 32 had a length of 5 cm or more. The findings were consistent between the two methods (χ2 = 0.357, P = 0.550), with a kappa consistency coefficient of 0.486. Pearson correlation analysis showed that the maximum tumor diameter and infiltration length measured using 3D RVT were positively correlated with clinical observations during surgery (r = 0.814 and 0.490, both P < 0.05). The 3D group had a shorter operative time (157.02 ± 8.38 vs 183.16 ± 23.87), less intraoperative blood loss (83.65 ± 14.22 vs 110.94 ± 22.05), and higher number of lymph node dissections (28.98 ± 2.82 vs 23.56 ± 2.77) and R0 resection rate (80.77% vs 61.64%) than the 2D group. Furthermore, the 3D group had shorter hospital stay [8 (8, 9) vs 13 (14, 16)], time to gas passage [3 (3, 4) vs 4 (5, 5)], and drainage tube removal time [4 (4, 5) vs 6 (6, 7)] than the 2D group. The complication rate was lower in the 3D group (11.54%) than in the 2D group (26.47%) (χ2 = 4.106, P < 0.05).

CONCLUSION

Using 3D RVT, doctors can gain a more comprehensive and intuitive understanding of the anatomy and related lesions of EGJ carcinomas, thus enabling more accurate surgical planning.

Current and emerging 3D visualization technologies in radiology

As the field of three-dimensional (3D) visualization rapidly advances, how healthcare professionals perceive and interact with real and virtual objects becomes increasingly complex. Lack of clear vocabulary to navigate the changing landscape of 3D visualization hinders clinical and scientific advancement, particularly within the field of radiology. In this article, we provide foundational definitions and illustrative examples for 3D visualization in clinical care, with a focus on the pediatric patient population. We also describe how understanding 3D visualization tools enables better alignment of hardware and software products with intended use-cases, thereby maximizing impact for patients, families, and healthcare professionals.

Lung Cancer Surgery in Octogenarians: Implications and Advantages of Artificial Intelligence in the Preoperative Assessment

The general world population is aging and patients are often diagnosed with early-stage lung cancer at an advanced age. Several studies have shown that age is not itself a contraindication for lung cancer surgery, and therefore, more and more octogenarians with early-stage lung cancer are undergoing surgery with curative intent. However, octogenarians present some peculiarities that make surgical treatment more challenging, so an accurate preoperative selection is mandatory. In recent years, new artificial intelligence techniques have spread worldwide in the diagnosis, treatment, and therapy of lung cancer, with increasing clinical applications. However, there is still no evidence coming out from trials specifically designed to assess the potential of artificial intelligence in the preoperative evaluation of octogenarian patients. The aim of this narrative review is to investigate, through the analysis of the available international literature, the advantages and implications that these tools may have in the preoperative assessment of this particular category of frail patients. In fact, these tools could represent an important support in the decision-making process, especially in octogenarian patients in whom the diagnostic and therapeutic options are often questionable. However, these technologies are still developing, and a strict human-led process is mandatory.

[Modern individualized diagnostics and treatment of non-small cell lung cancer]

Approximately one half of patients with non-small cell lung cancer (NSCLC) are diagnosed at resectable tumor stages (I-IIIA), which can potentially be curatively treated. In the early tumor stages (tumor diameter ≤2 cm) sublobar resection (segmentectomy or atypical wedge resection) leads to a 5‑year long-term survival comparable to lobectomy. The use of immunotherapy, especially within the framework of neoadjuvant treatment, is anticipated to change the surgical treatment of NSCLC in the future. With the introduction of lung cancer screening for certain risk groups in Germany planned for 2024, lung tumors can be expected to be diagnosed at earlier stages and more frequently curatively treated. This article provides an overview of the potential impact of lung cancer screening, modern minimally invasive surgical techniques and neoadjuvant treatment concepts for the surgical treatment of NSCLC.

Developing a Virtual Reality Simulation System for Preoperative Planning of Robotic-Assisted Thoracic Surgery

Background. Robotic-assisted thoracic surgery (RATS) is now standard for lung cancer treatment, offering advantages over traditional methods. However, RATS's minimally invasive approach poses challenges like limited visibility and tactile feedback, affecting surgeons' navigation through com-plex anatomy. To enhance preoperative familiarization with patient-specific anatomy, we devel-oped a virtual reality (VR) surgical navigation system. Using head-mounted displays (HMDs), this system provides a comprehensive, interactive view of the patient's anatomy pre-surgery, aiming to improve preoperative simulation and intraoperative navigation. Methods. We integrated 3D data from preoperative CT scans into Perspectus VR Education software, displayed via HMDs for in-teractive 3D reconstruction of pulmonary structures. This detailed visualization aids in tailored preoperative resection simulations. During RATS, surgeons access these 3D images through Tile-ProTM multi-display for real-time guidance. Results. The VR system enabled precise visualization of pulmonary structures and lesion relations, enhancing surgical safety and accuracy. The HMDs offered true 3D interaction with patient data, facilitating surgical planning. Conclusions. VR sim-ulation with HMDs, akin to a robotic 3D viewer, offers a novel approach to developing robotic surgical skills. Integrated with routine imaging, it improves preoperative planning, safety, and accuracy of anatomical resections. This technology particularly aids in lesion identification in RATS, optimizing surgical outcomes.

Harnessing 3D-CT Simulation and Planning for Enhanced Precision Surgery: A Review of Applications and Advancements in Lung Cancer Treatment

The clinical application of three-dimensional computed tomography (3D-CT) technology has rapidly expanded in the last decade and has been applied to lung cancer surgery. Two consecutive reports of large-scale prospective clinical trials from Japan and the United States have brought a paradigm shift in lung cancer surgery and may have led to a rapid increase in sublobar lung resections. Sublobar resection, especially segmentectomy, requires a more precise understanding of the anatomy than lobectomy, and preoperative 3D simulation and intraoperative navigation support it. The latest 3D simulation software packages are user-friendly. Therefore, in this narrative review, we focus on recent attempts to apply 3D imaging technologies, particularly in the sublobar resection of the lung, and review respective research and outcomes. Improvements in CT accuracy and the use of 3D technology have advanced lung segmental anatomy. Clinical applications have enabled the safe execution of complex sublobar resection through a minimally invasive approach, such as video-assisted thoracoscopic surgery and robotic surgery. However, currently, many facilities still render 3D images on two-dimensional monitors for usage. In the future, it will be challenging to further spread and advance intraoperative navigation through the application of 3D output technologies such as extended reality.

Collaborative Virtual Reality Real-Time 3D Image Editing for Chest Wall Resections and Reconstruction Planning

The integration of extended reality (XR) technologies into health care procedures presents transformative opportunities, particularly in surgical processes. This study delves into the utilization of virtual reality (VR) for preoperative planning related to chest wall resections in thoracic surgery. Leveraging the capabilities of 3-dimensional (3D) imaging, real-time visualization, and collaborative VR environments, surgeons gain enhanced anatomical insights and can develop predictive surgical strategies. Two clinical cases highlighted the effectiveness of this approach, showcasing the potential for personalized and intricate surgical planning. The setup provides an immersive, dynamic representation of real patient data, enabling collaboration among teams from separate locations. While VR offers enhanced interactive and visualization capabilities, preliminary evidence suggests it may support more refined preoperative strategies, potentially influence postoperative outcomes, and optimize resource management. However, its comparative advantage over traditional methods needs further empirical validation. Emphasizing the potential of XR, this exploration suggests its broad implications in thoracic surgery, especially when dealing with complex cases requiring multidisciplinary collaboration in the immersive virtual space, often referred to as the metaverse. This innovative approach necessitates further examination, marking a shift toward future surgical preparations. In this article, we sought to demonstrate the technique of an immersive real-time volume-rendered collaborative VR-planning tool using exemplary case studies in chest wall surgery.

Tumor Lung Visualization and Localization through Virtual Reality and Thermal Feedback Interface

The World Health Organization estimates that there were around 10 million deaths due to cancer in 2020, and lung cancer was the most common type of cancer, with over 2.2 million new cases and 1.8 million deaths. While there have been advances in the diagnosis and prediction of lung cancer, there is still a need for new, intelligent methods or diagnostic tools to help medical professionals detect the disease. Since it is currently unable to detect at an early stage, speedy detection and identification are crucial because they can increase a patient's chances of survival. This article focuses on developing a new tool for diagnosing lung tumors and providing thermal touch feedback using virtual reality visualization and thermal technology. This tool is intended to help identify and locate tumors and measure the size and temperature of the tumor surface. The tool uses data from CT scans to create a virtual reality visualization of the lung tissue and includes a thermal display incorporated into a haptic device. The tool is also tested by touching virtual tumors in a virtual reality application. On the other hand, thermal feedback could be used as a sensory substitute or adjunct for visual or tactile feedback. The experimental results are evaluated with the performance comparison of different algorithms and demonstrate that the proposed thermal model is effective. The results also show that the tool can estimate the characteristics of tumors accurately and that it has the potential to be used in a virtual reality application to "touch" virtual tumors. In other words, the results support the use of the tool for diagnosing lung tumors and providing thermal touch feedback using virtual reality visualization, force, and thermal technology.

Immersive Virtual Reality for Patient-Specific Preoperative Planning: A Systematic Review

Background. Immersive virtual reality (iVR) facilitates surgical decision-making by enabling surgeons to interact with complex anatomic structures in realistic 3-dimensional environments. With emerging interest in its applications, its effects on patients and providers should be clarified. This systematic review examines the current literature on iVR for patient-specific preoperative planning. Materials and Methods. A literature search was performed on five databases for publications from January 1, 2000 through March 21, 2021. Primary studies on the use of iVR simulators by surgeons at any level of training for patient-specific preoperative planning were eligible. Two reviewers independently screened titles, abstracts, and full texts, extracted data, and assessed quality using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Results were qualitatively synthesized, and descriptive statistics were calculated. Results. The systematic search yielded 2,555 studies in total, with 24 full-texts subsequently included for qualitative synthesis, representing 264 medical personnel and 460 patients. Neurosurgery was the most frequently represented discipline (10/24; 42%). Preoperative iVR did not significantly improve patient-specific outcomes of operative time, blood loss, complications, and length of stay, but may decrease fluoroscopy time. In contrast, iVR improved surgeon-specific outcomes of surgical strategy, anatomy visualization, and confidence. Validity, reliability, and feasibility of patient-specific iVR models were assessed. The mean QATSDD score of included studies was 32.9%. Conclusions. Immersive VR improves surgeon experiences of preoperative planning, with minimal evidence for impact on short-term patient outcomes. Future work should focus on high-quality studies investigating long-term patient outcomes, and utility of preoperative iVR for trainees.

The effect of virtual reality on temporal bone anatomy evaluation and performance

PURPOSE

There is only limited data on the application of virtual reality (VR) for the evaluation of temporal bone anatomy. The aim of the present study was to compare the VR environment to traditional cross-sectional viewing of computed tomography images in a simulated preoperative planning setting in novice and expert surgeons.

METHODS

A novice (n = 5) and an expert group (n = 5), based on their otosurgery experience, were created. The participants were asked to identify 24 anatomical landmarks, perform 11 distance measurements between surgically relevant anatomical structures and 10 fiducial markers on five cadaver temporal bones in both VR environment and cross-sectional viewings in PACS interface. The data on performance time and user-experience (i.e., subjective validation) were collected.

RESULTS

The novice group made significantly more errors (p < 0.001) and with significantly longer performance time (p = 0.001) in cross-sectional viewing than the expert group. In the VR environment, there was no significant differences (errors and time) between the groups. The performance of novices improved faster in the VR. The novices showed significantly faster task performance (p = 0.003) and a trend towards fewer errors (p = 0.054) in VR compared to cross-sectional viewing. No such difference between the methods were observed in the expert group. The mean overall scores of user-experience were significantly higher for VR than cross-sectional viewing in both groups (p < 0.001).

CONCLUSION

In the VR environment, novices performed the anatomical evaluation of temporal bone faster and with fewer errors than in the traditional cross-sectional viewing, which supports its efficiency for the evaluation of complex anatomy.

Immersive Three-dimensional Computed Tomography to Plan Chest Wall Resection for Lung Cancer

PURPOSE

Chest wall resections for lung cancer treatment remain difficult to plan using standard two-dimensional computed tomography. Although virtual reality headsets have been used in many medical contexts, they have not been employed in chest wall resection planning.

DESCRIPTION

We compared preoperative planning of a chest wall surgical resection for lung cancer treatment between senior and resident surgeons who used an immersive virtual reality device and a two-dimensional computed tomography.

EVALUATION

Chest wall resection planning was more accurate when surgeons used virtual reality versus computed tomography analysis (28.6% vs. 18.3%, p = 0.018), and this was particularly true in the resident surgeon group (27.4% vs. 8.3%, p = 0.0025). Predictions regarding the need for chest wall substitutes were also more accurate when they were made using virtual reality versus computed tomography analysis in all groups (96% vs. 68.5%, p < 0.0001). Other studied parameters were not affected by use of the virtual reality tool.

CONCLUSION

Virtual reality may offer enhanced accuracy for chest wall resection and reconstruction planning for lung cancer treatment.

Artificial intelligence assisted display in thoracic surgery: development and possibilities

In this golden age of rapid development of artificial intelligence (AI), researchers and surgeons realized that AI could contribute to healthcare in all aspects, especially in surgery. The popularity of low-dose computed tomography (LDCT) and the improvement of the video-assisted thoracoscopic surgery (VATS) not only bring opportunities for thoracic surgery but also bring challenges on the way forward. Preoperatively localizing lung nodules precisely, intraoperatively identifying anatomical structures accurately, and avoiding complications requires a visual display of individuals’ specific anatomy for surgical simulation and assistance. With the advance of AI-assisted display technologies, including 3D reconstruction/3D printing, virtual reality (VR), augmented reality (AR), and mixed reality (MR), computer tomography (CT) imaging in thoracic surgery has been fully utilized for transforming 2D images to 3D model, which facilitates surgical teaching, planning, and simulation. AI-assisted display based on surgical videos is a new surgical application, which is still in its infancy. Notably, it has potential applications in thoracic surgery education, surgical quality evaluation, intraoperative assistance, and postoperative analysis. In this review, we illustrated the current AI-assisted display applications based on CT in thoracic surgery; focused on the emerging AI applications in thoracic surgery based on surgical videos by reviewing its relevant researches in other surgical fields and anticipate its potential development in thoracic surgery.

Developing Virtual Reality Head Mounted Display (HMD) Set-Up for Thoracoscopic Surgery of Complex Congenital Lung MalFormations in Children

Video assisted thoracoscopic surgery (VATS) has been adopted in pediatric age for the treatment of congenital lung malformations (CLM). The success of VATS in pediatrics largely depends on the surgeon's skill ability to understand the airways, vascular system and lung parenchyma anatomy in CLM. In the last years, virtual reality (VR) and 3-dimensional (3D) printing of organ models and VR head mounted display (HMD) technologies have been introduced for completion of preoperative planning in adult patients. To date no reports about the use of VR HMD technologies in a pediatric setting are available. The aim of this report is to introduce a VR HMD model in VATS procedure to improve the quality of care in children with CLM. VR HMD set-up for planning thoracoscopic surgery was performed in a series of pediatric patients with diagnosis of CLM. The preoperative VR HMD evaluation allowed a navigation into the malformation with the aim to explore, interact, and make the surgeon more confident and skilled to answer to the traps. A development of surgical simulations models and teaching program dedicated to education and training in pediatric VATS is suitable among the pediatric surgery community. Further studies should demonstrate all the benefits of such technology in pediatric patients submitted to VATS procedure.

Modified thoracoscopic wedge resection of limited peripheral lesions in S10 for children with congenital pulmonary airway malformation: Initial single-center experience

OBJECTIVE

The present study aimed to evaluate the safety and feasibility of modified thoracoscopic wedge resection of limited peripheral lesions in the posterior basal segment (S10) in children with congenital pulmonary airway malformation (CPAM).

MATERIALS AND METHODS

We retrospectively analyzed the clinical data of children with CPAM who underwent thoracoscopic modified wedge resection at our institution from November 2020 to February 2022. The surgical method was as follows: we marked the external boundary of the lesion with an electric hook, dissected and retained the segmental vein between the lesion and normal lung tissue as the internal boundary, cut the arteries, veins, and bronchus entering the lesion, and cut and sealed the lung tissue between the internal and external boundaries with LigaSure™ to complete the modified wedge resection.

RESULTS

A total of 16 patients were included, aged 3.8-70.0 months and weighing 6.5-21.0 kg. The intraoperative course was uneventful in all patients. The median operation time and intraoperative bleeding volume were 74 min (50-110 min) and 5 mL (5-15 mL), respectively. The median postoperative drainage tube indwelling time was 3 days (2-4 days), and the median postoperative hospital stay was 6 days (4-8 days). Pathological diagnosis included two cases of type 1, 10 cases of type 2, and four cases of type 3 CPAM. There were no cases of intraoperative conversion, surgical mortality, or major complications. However, subcutaneous emphysema occurred in two children, which spontaneously resolved without pneumothorax orbronchopleural fistula development. All patients were followed up for a median period of 10 months (3-18 months), and there were no cases of hemoptysis or residual lesions on chest computed tomography.

CONCLUSION

Modified thoracoscopic wedge resection via the inferior pulmonary ligament approach is safe and feasible for children with CPAM with limited peripheral lesions in S10.