Uniportal VATS right apical segmentectomy (S1):a case report and the surgical technique

Lobectomy has long been considered the standard procedure for early-stage non-small cell lung cancer. However, the interest in sub-lobar resections (i.e., segmentectomy) is increasing. Especially to be applied in patients with small tumors and marginal cardiopulmonary function. Yet, performing a segmentectomy through video-assisted thoracoscopic surgery (VATS) may be technically challenging, and even more challenging if performed through a uniportal approach. The objective of the current study is to describe and visualize the surgical technique of uniportal thoracoscopic segmentectomy by means of a case report. We present the case of a 58-year-old female in whom 18F-deoxyglucose positron emission tomography (FDG-PET)-computed tomography (CT) showed a 17-millimeter metabolically active lesion in segment 1 (S1; cTNM, cT1bN0M0 stage IA2). The patient was scheduled for a uniportal VATS right apical segmentectomy of S1 with additional mediastinal lymph node resection. The case and surgical technique were described and visualized. The surgical steps included adhesiolysis, dissection of the hilar structures, exposure and subsequent stapling of the A1 and V1a branch, exposure of the B1 bronchus branch and confirming exclusion of B1 prior to stapling, marking of the intersegmental planes with the use of indocyanine green and near-infrared fluorescence, stapling of the intersegmental parenchyma and an additional mediastinal lymph node resection. The recovery was uneventful

The Automatic Quantification of Morphological Features of Pectus Excavatum Based on Three-Dimensional Images

Visual examination and quantification of severity are essential for clinical decision making in patients with pectus excavatum. Yet, visual assessment is prone to inter- and intra-observer variability and current quantitative methods are inadequate. This study aims to develop and evaluate a novel, automatic and non-invasive method to objectively quantify pectus excavatum morphology based on three-dimensional images. Key steps of the automatic analysis are normalization of image orientation, slicing, and computation of the morphological features encompassing pectus depth, width, length, volume, position, steepness, flaring, asymmetry and mean cross-sectional area. A digital phantom mimicking a patient with pectus excavatum was used to verify the analysis method. Prospective three-dimensional imaging and subsequent surface analysis in patients with pectus excavatum was performed to assess clinical feasibility. Verification of the developed analysis tool demonstrated 100% reproducibility of all morphological feature values. Calculated parameters compared to the predetermined phantom dimensions were accurate for all but four features. The pectus width, length, volume and steepness showed an error of 4 mm (4%), 2 mm (2%), 12 mL (5%) and 1 degree (3%), respectively. Prospective imaging of 52 patients (88% males) demonstrated the feasibility of the developed tool to quantify morphological features of pectus excavatum in the clinical setting. Mean duration to calculate all features in one patient was 7.6 seconds. We have developed and presented a non-invasive pectus excavatum surface analysis tool, that is feasible to automatically quantify morphological features based on three-dimensional images with promising accuracy and reproducibility