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Ann Thorac Surg 2007;84:995-999
© 2007 The Society of Thoracic Surgeons

New Technology

Virtual Mediastinoscopy for Safer and More Accurate Mediastinal Exploration

Hiroyuki Shiono, MDa,b,*, Meinoshin Okumura, MDa, Noriyoshi Sawabata, MDb, Tomoki Utsumi, MDb, Masayoshi Inoue, MDb, Masato Minami, MDb, Noriyuki Tomiyama, MDc, Hikaru Matsuda, MDd, Yoshiki Sawa, MDa,b

a Medical Center for Translational Research, Osaka University Hospital, Osaka, Japan
b Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
c Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
d Hyogo College of Medicine, Hyogo, Japan

Accepted for publication March 19, 2007.

* Address correspondence to Dr Shiono, Medical Center for Translational Research, Osaka University Hospital, 2-15 Yamada-oka, Suita, Osaka, 565-0871, Japan (Email: hishiro{at}surg1.med.osaka-u.ac.jp).

Purpose: Virtual endoscopy can theoretically produce images of hollow organs from computed tomographic scanning by discriminating walls with the air space. We produced virtual images of the mediastinum (ie, virtual mediastinoscopy based on positron emission tomography and computed tomography scanning data to visualize lymph nodes and great vessels similar to cervical mediastinoscopy).

Description: Virtual images from 5 patients with positive mediastinal positron emission tomography findings were produced using computer software designed for virtual endoscopy. Visualization of lymph nodes and vessels was done based on positron emission tomography-computed tomography and enhanced computed tomographic scanning data, respectively.

Evaluation: Virtual mediastinoscopy clearly showed three-dimensional relationships between active nodes and surrounding structures. Great vessels, such as the innominate artery and azygos vein, which require assessment during a mediastinoscopy, were visualized in virtual movies. Further, perspective views in the craniocaudal direction based on surgeon-orientation, simulated actual views were obtained during cervical video mediastinoscopy.

Conclusions: Virtual mediastinoscopy provided realistic images of the mediastinal anatomy, and has the potential to make cervical mediastinoscopy and other mediastinal explorations safer, as well as more accurate.


Related Article

Invited commentary
Keith D. Mortman
Ann. Thorac. Surg. 2007 84: 1000. [Extract] [Full Text] [PDF]



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K. D. Mortman
Invited commentary
Ann. Thorac. Surg., September 1, 2007; 84(3): 1000 - 1000.
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