Three-dimensional simulation-based wedge resection for non-palpable small lung lesions.

Three-dimensional simulation is widely used for anatomical segmentectomy, but its application to wedge resection is less standardized. We describe a 3D simulation-based wedge resection technique for selected non-palpable small lung lesions, particularly those in which intraoperative localization is difficult because of their depth or small size. Preoperative simulation identifies preserved intrapulmonary bronchovascular structures and defines a landmark-constrained transection surface with an adequate margin. During thoracoscopic surgery, these structures are exposed as landmarks, not divided as in anatomical segmentectomy, and staplers are applied along the planned surface. The technique is intended for lesions for which wedge resection is oncologically acceptable but empirical stapled wedge resection may provide unreliable localization or margin control. In selected patients, 3D simulation-based wedge resection may be a useful adjunct for planning localization- and margin-oriented parenchyma-sparing resection.