Three-dimensional virtual lung reconstruction in robotic segmentectomy: A safety and feasibility trial

Objective: Robotic pulmonary segmental resection is a technically challenging procedure. Near-infrared fluorescence mapping with intravascular indocyanine green dye is a valuable adjunct; however, conversion to lobectomy still occurs in up to 40% of cases. We hypothesized that the incorporation of 3-dimensional virtual lung reconstruction would result in low rates of conversion from segmentectomy to lobectomy and increased confidence in the surgical plan. Methods: A prospective single-center cohort trial was conducted to determine the safety and feasibility of this approach. Patients undergoing robotic segmentectomy for clinical stage I non-small cell lung cancer less than 3 cm were enrolled, and 3-dimensional reconstruction was performed with confidence scores assigned before and after 3-dimensional reconstruction. Adverse events, rates of conversion to lobectomy, and changes in confidence scores were recorded and analyzed. Results: A total of 79 patients were enrolled from December 2022 to April 2024, and 76 patients (96.20%) underwent surgery. Three-dimensional reconstruction was successfully performed in 88.16% (67/76) of cases, and indocyanine green dye was used in 68.66% (46/67) with no adverse events related to its use. The 30-day mortality was 1.49% (1/59). The majority of patients (80.60%; 54/67) underwent a successful segmentectomy, whereas 8.96% (6/67) of cases were converted to lobectomy after segmentectomy was started. The planned operation was modified after 3-dimensional reconstruction in 36.07% (22/61) of cases leading to a significant increase in confidence scores (P < .001). Conclusions: Three-dimensional lung reconstruction in targeted robotic segmental resection is associated with low rates of conversion to lobectomy and increased surgeon confidence. Further studies are warranted to establish the effectiveness of this technique.