Preoperative Holographic Assessment of Pulmonary Anatomy for Intralobar Sequestration

This video shows the case of a thirty-eight-year-old patient with a previous history of colonic cancer and Lynch syndrome. She was referred to the thoracic surgery department because of a pulmonary mass in the right lower lobe.

Chest computed tomography and holographic reconstruction disclosed a transdiaphragmatic feeding artery from the abdominal aorta entering the pulmonary lesion, thus suggesting an intralobar pulmonary sequestration.

Thanks to the holographic reconstruction based on a preoperative standard CT scan, the surgical team was able to stretch and rotate the entire image to better visualize all vascular structures. The feeding artery from the aorta, pulmonary arteries (in red) and veins (in blue), as well as the entire tracheobronchial tree (light blue) could all be clearly seen. Thanks to selective visualization, all the branches of the pulmonary artery to the right lower lobe could be identified.

In order to better localize the artery branches after visualizing the pulmonary artery together with the bronchial tree, the bronchial tree was removed and only the artery branches were focused on. The arteries were then removed to better visualize only the bronchial tree (light blue), its relations with the sequestration, and the feeding artery course.

Next, the venous system was visualized, disclosing the standard anatomy of the right lower pulmonary vein and subsequently reintroducing the pulmonary artery system, the aortic feeding artery, and the entire aorta to have a global view of the surgical field.

The pulmonary inflated parenchyma was then introduced to clearly visualize the sequestration within the lobe. Thanks to complete rotation of the model, surgeons were able to have a dedicated view from the base of the lung.

References

1. Gabor D. A new microscopic principle. Nature. 161 (4098): 777–8
2. Triberti S, Petrella F, Gorini A, Pappalardo O, Sebri V, Savioni L, Redaelli A, Pravettoni G. Augmenting surgery: medical students' assessment and ergonomics of 3D holograms vs. CT Scans for pre- operative planning. EAI Endorsed Trans. Pervasive Health Technol. 2021; 7(25):e5.
3. Petrella F, Spaggiari L Preoperative Holographic Assessment of Pulmonary Anatomy CTSnet January 17, 2022

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