Since November, Emory surgeons have been piloting new software that creates a three-dimensional digital image of a patient's lungs. Having access to a 3D model makes removing hard-to-reach cancerous cells more efficient and precise. Think of it as the first time a cartographer added mountains and canyons to the layout of a map—only in this case, that map leads straight to saving a patient's life.
At Emory Saint Joseph's Hospital (ESJH), Manu Sancheti, MD, and his team are the first thoracic surgeons in the Southeast, and only the third in the country, to explore how this new Intuitive 3D Modeling tool can aid robotic-assisted thoracic surgery.
Non-small cell lung cancer, in particular – the kind that most benefits from robotic surgery and 3D imaging – can often be challenging to pinpoint and remove since the tissue samples can exist deep within the lung. With a combination of robotic-assisted surgery and these enhanced imaging techniques, it is quicker and easier to figure out how to approach suspicious-looking nodules.
The detailed, three-dimensional rendering of a patient's lung can help Sancheti and team as they perform complex, robotic-assisted surgery.
To produce a highly detailed 3D model of the patient's lung, Sancheti uses a patient's CT scan, a two-dimensional image routinely used to screen patients for potential cancerous tissue in the lung. Then, he feeds it into the new software, which produces a unique 3D model of the patient's lung, including the location, proportions, and size of the tumor that needs to be removed.
As the operation progresses, Sancheti and his team use the model to help guide them in the precise placement of blood vessels, veins, arteries, and the other internal workings of the lung.
That added detail and dimension to the image of the patient's lung helps Sancheti and team prepare a plan of action before anyone enters the operating room, setting the stage for a smoother and quicker surgery.
Before they began using 3D imaging, Sancheti said he and his team would pour over the 2D CT scan and "try to develop a mental picture in our heads of what it would look like three-dimensionally. But many times, my discussions with the patients in that situation would be, I'm going to go in and try to do this, but I may have to take a number of different paths to get there.”
Now, with the 3D model, Sancheti still has a comprehensive conversation with his patients, but he adds that he's making a 3D model, which will give them an exact action plan. To go back to the map comparison – they'll now know where the sharp peaks and chasms lie and how to navigate around those troublesome areas.
The adoption of this new technique builds upon Emory Heart & Vascular's lengthy history of pioneering advancements in patient care. Four years ago, Sancheti and his team at ESJH became the first in the state to use a new state-of-the-art robot to diagnose lung cancers earlier and less invasively.
Emory also leads the way nationally with robotic surgery—currently, 90% of thoracic surgeries are performed using minimally invasive techniques, which results in less pain, shorter hospital stays, and quicker overall recovery for patients.
Sancheti (left) chats with surgical colleagues at Emory Saint Joseph's Hospital in 2023.
The 3D imaging also makes the surgery more precise, preserving more parts of the lung because Sancheti knows exactly where the tumor is and potentially can minimize the amount of lung removed while still providing an appropriate operation for the patient.
As a result, surgeries take less time, tend to have fewer complications, and can be more exacting about how much of the lung needs to be removed to successfully get the tumor out. Sancheti says keeping intact even a fraction of healthier lung tissue can make a dramatic difference in patient recovery time, minimizing shortness of breath and enhancing the level of possible activity post-operation.
Right now, the thoracic surgery department at ESJH is the sole team implementing the 3D imaging software, but Sancheti said that the goal is also to expand these techniques across the Emory Health Care system to help with other kinds of surgeries and treat other types of illnesses.
Looking ahead, Sancheti is also excited for Emory to become the country's first academic medical center to use 3D imaging for patient education.
"If I can get a patient's scans before they come to the office, I can get the model made, which takes a few days, and then I could use an iPad or I could use a virtual reality headset and essentially show the patient, 'this is your tumor, this is what we're removing, these are the blood vessels,'" he says. "It's just another great example of how technology is changing how we do things in terms of pre-op preparation."
Sancheti has been at Emory since 2011, when he joined the School of Medicine faculty following his cardiothoracic surgery residency and is currently Associate Professor of Surgery. He is also the director of robotic thoracic surgery at Emory and a member of the Cancer Prevention and Control Research Program at Winship Cancer Institute.