title: Three-dimensional surgical simulation-guided navigation in thoracic surgery: a new approach to improve results in chest wall resection and reconstruction for malignant diseases.
abstract: OBJECTIVE
  Oncological surgery of the chest wall should be performed to achieve free margins of at least 2 cm for metastasis or 4 cm for primary tumours. When the lesion is not visible or palpable, difficulty in identification may lead to a larger incision and a resection wider than is necessary.
  
  
  METHODS
  We report three cases of non-palpable metastatic chest wall lesions in which the preoperative surgical planning and the intraoperative identification of the tumour, and thus the subsequent chest wall reconstruction, was supported using computer-based surgery.
  
  
  RESULTS
  The application of high-resolution three-dimensional imaging technology and navigational systems is used in preoperative surgical planning to provide virtual simulations of a patient's skeletal changes and new soft tissue profile. Intraoperatively, a mobile navigation probe was used to identify the lesion, matching surgical landmarks and the preoperative computed tomography imaging, achieving the radical resection of the tumour with correct but not excessive surgical margins. Two patients underwent partial sternectomy followed by sternal allograft reconstruction. The third patient underwent chest wall resection followed by reconstruction using titanium bars and vicryl mesh. In all cases, the postoperative period was uneventful. After a follow-up period of 13.9 and 8 months, respectively, all patients are disease free, without complications.
  
  
  CONCLUSIONS
  Application of navigation technology in thoracic surgery should be encouraged because it is easy to use and requires a limited learning curve.
authors.affiliation: Thoracic Surgery Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Stella
authors.forename: Giampiero
authors.initials: G
authors.lastname: Dolci
authors.forename: Andrea
authors.initials: A
authors.lastname: Dell'Amore
authors.forename: Giovanni
authors.initials: G
authors.lastname: Badiali
authors.forename: Massimo
authors.initials: M
authors.lastname: De Matteis
authors.forename: Nizar
authors.initials: N
authors.lastname: Asadi
authors.forename: Claudio
authors.initials: C
authors.lastname: Marchetti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bini
mesh_terms: D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D016025:Bone Transplantation; D003198:Computer Simulation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D019651:Plastic Surgery Procedures; D013249:Sternum / Q000000981:diagnostic imaging / Q000601:surgery*; D025321:Surgery, Computer-Assisted; D013899:Thoracic Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Chest wall; Computed-aided surgery; Simulation-guided navigation; Sternal transplantation; Thoracic surgery; Virtual surgery simulation