mHealth Research Digest with Mohamed Elawad

Resecting a lung segment can be a challenging procedure for surgeons due to the variety and complexity of segmental lung anatomy. Nevertheless, it has become an increasingly common procedure for removal of lung tumors and other indications. Recently, researchers in Japan conducted a study to assess whether there are any benefits from the intra-operative use of 3D imaging navigation, in this case through the use of an iPad, while performing such a procedure.The study was conducted on fourteen patients, between October 1st 2010 and April 30th 2011, who had undergone an anatomic segmentectomy for a primary lung cancer or a metastatic lung tumor. 3D images viewed through an iPad using DICOM image viewer software were analyzed during procedures.Images had been obtained through contrast-enhanced scanning. Images showed the pulmonary vein and artery, airway from the trachea to the subsegmental bronchus and the tumor to be removed. Included in the results of surgery for each patient were the type of segmentology, histology, duration of surgery and amount of blood lost.29881_3d ipad 1

While kept in a sterile bag, the iPad was used to navigate through the 3D image, and used to identify unusual branches of the pulmonary vessels and bronchi as well as intersegmental veins. Through the aid of 3D navigation the surgeons were able to “avoid intra-operative bleeding, post-operative impediment of blood flow or ventilator defects” according to the researchers. 3D navigation also enabled “the appropriate dissection of the pulmonary parenchyma with a sufficient margin from the tumor.” The researchers reported that the use of an iPad for 3D images helped them to “properly identify these anatomical structures and thereby recognize the precise positional relationship between them and the lesions to be resected.” As a result, more difficult segmentololgies have been performed more frequently at the medical institutions of the authors due to the surgeons being more confident about safely performing the procedures.There were some limitations to 3D CT navigation as noted by the researchers. Among them were the time taken to generate the images, one hour in this case, and that small branches of pulmonary vessels or bronchus cannot be visualized through this method.This study demonstrates the usefulness of devices such as the iPad in the operating room as a surgical aid.

Authors:

Takashi Eguchia, Keiichiro Takasunaa, Atsushi Kitazawac, Youhei Fukuzawac, Yasuo Sakauec, Kazuo Yoshidab, Makoto Matsubarac

 

Institutions:

  • Department of Thoracic Surgery, Ina Central Hospital, Ina, Japan
  • Department of Radiology, Ina Central Hospital, Ina, Japan
  • Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan

Original Abstract:

European Journal of Cardio-Thoracic Surgery