Harnessing 3D-CT Simulation and Planning for Enhanced Precision Surgery: A Review of Applications and Advancements in Lung Cancer Treatment

SIMPLE SUMMARY: Due to the increasing incidence of early-stage lung cancer and the demand for less invasive surgeries, sublobar resections are rapidly increasing in the field of lung cancer surgery. Recently, three-dimensional imaging technology and software solutions that enable highly precise lung segmentectomy simulations have been developed. In this article, we review reports on recent three-dimensional technology and its application in lung cancer surgery, introduce precision lung segmentectomies performed at our facility, and discuss its limitations. In the future, more accurate recognition of anatomical structures between the pulmonary artery, vein, and bronchus using artificial intelligence technology, visualization of anatomical structures using immersive technology such as extended reality, and devices that can be used intraoperatively without obstructing the operative field will be developed. If these advancements are realized, we believe that further high-quality tailor-made sublobar resections for lung cancer will be possible. ABSTRACT: The clinical application of three-dimensional computed tomography (3D-CT) technology has rapidly expanded in the last decade and has been applied to lung cancer surgery. Two consecutive reports of large-scale prospective clinical trials from Japan and the United States have brought a paradigm shift in lung cancer surgery and may have led to a rapid increase in sublobar lung resections. Sublobar resection, especially segmentectomy, requires a more precise understanding of the anatomy than lobectomy, and preoperative 3D simulation and intraoperative navigation support it. The latest 3D simulation software packages are user-friendly. Therefore, in this narrative review, we focus on recent attempts to apply 3D imaging technologies, particularly in the sublobar resection of the lung, and review respective research and outcomes. Improvements in CT accuracy and the use of 3D technology have advanced lung segmental anatomy. Clinical applications have enabled the safe execution of complex sublobar resection through a minimally invasive approach, such as video-assisted thoracoscopic surgery and robotic surgery. However, currently, many facilities still render 3D images on two-dimensional monitors for usage. In the future, it will be challenging to further spread and advance intraoperative navigation through the application of 3D output technologies such as extended reality.