Three-dimensional reconstruction and virtual simulation of patient-specific anatomy for procedural planning in thoracoscopic segmentectomy: A systematic review and meta-analysis

BACKGROUND: Three-dimensional reconstruction of patient-specific anatomy and virtual simulation for procedural planning in thoracoscopic segmentectomy could theoretically improve the clinical outcomes. Therefore, the aim of this study was to evaluate the contemporary evidence to test this hypothesis. METHODS: Four databases (PubMed, Embase, Cochrane Library, Web of Science) were searched for articles published before October 12, 2024. Intraoperative parameters (operative time, intraoperative blood loss, the number of lymph node resections, inadequate margin) and postoperative parameters (postoperative complications, total chest drainage, chest tube duration, postoperative hospital stay) were the comparative end-points. RESULTS: A total of 10 articles were included in this study. 772 patients were in the three-dimensional (3D) reconstruction group and 652 patients were in the non-three-dimensional (non-3D) reconstruction group. The procedural planning with 3D reconstruction and simulation reduced the probability of inadequate surgical margins (Odds ratio [OR] = 0.09; 95% confidence interval (CI)  = 0.02-0.50; P = .006) and postoperative complication rates (OR = 0.53; 95% CI = 0.38-0.74; P < .001). In the subgroup analysis, 3D reconstruction reduced the operative time (Mean difference [MD] = -10.85 min; 95% CI = -15.39 to -6.02, P < .001) and intraoperative blood loss (MD = -5.41 ml; 95% CI = -9.87 to -0.94, P = .020) in complex segmentectomies. As for the number of lymph node resections, chest tube duration, total chest drainage, and postoperative hospital stay, the 2 groups were similar with no statistically significant difference. CONCLUSIONS: Patient-specific 3D reconstruction and simulation for procedural planning in segmentectomy may help reduce the probability of inadequate surgical margins and complications. In complex segmental resections, it may shorten the operative time and reduce intraoperative blood loss.