Objective To assess the clinical value of preoperative localization coupled with computed tomography (CT) three-dimensional reconstruction in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection. Methods The clinical data of 30 patients of combined subsegmental/segmental resection in our hospital from December 2019 to October 2021 were retrospectively collected. There were 19 males and 11 females with the mean age of 56.4 (32.0-71.0) years. The pulmonary nodules were located by CT-guided injection of glue before operation. The three-dimensional reconstruction image and operation planning were carried out by Mimics 21.0 software. ResultsThe operations were all successfully performed, and there was no conversion to open thoracotomy or lobectomy. The mean tumor diameter was 11.6±3.5 mm, the mean distance between the nodule and the visceral pleura was 13.6±5.6 mm, the mean width of the actual cutting edge was 25.0±6.5 mm, the mean operation time was 110.2±23.8 min, the mean number of lymph node dissection stations was 6.5±2.4, the mean amount of intraoperative bleeding was 50.8±20.3 mL, the mean retention time of thoracic catheter was 3.2±1.1 d, and the mean postoperative hospital stay was 4.5±1.7 d. There was 1 patient of subcutaneous emphysema, 1 patient of atrial fibrillation and 1 patient of blood in sputum. Conclusion Preoperative CT-guided injection of medical glue combined with CT three-dimensional reconstruction of pulmonary bronchus and blood vessels is safe and feasible in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection, which ensures the surgical margin and reserves lung tissues.
How to accurately locate pulmonary nodules in thoracic surgery is a key challenge in surgery. "Chinese expert consensus on preoperative assisted positioning technology of pulmonary nodules (2025 Edition)" (hereafter referred to as the consensus) is an update version incorporating the latest evidence and clinical practice based on the 2019 edition, aiming to provide reference for clinical practice. The consensus summarizes commonly used preoperative assisted positioning technologies, such as percutaneous lung puncture positioning (Hookwire positioning needles, metal spring coils, etc.), transbronchial puncture positioning (electromagnetic navigation bronchoscopes, etc.), and virtual reality and 3D printing positioning, and introduces the application indications, operating specifications and potential complications of different positioning technologies, analyzes the existing technical advantages and shortcomings, and emphasizes the selection of the most appropriate positioning method according to the specific situation of the patient, so as to improve the success rate and safety of the surgery, and promotes the minimally invasive and precise development of thoracic surgery.