A new method of infrared-fluorescence-enhanced thoracoscopic segmentectomy

Elkhouly, Ahmed; Cristino, Benedetto; Pompeo, Eugenio

doi:10.1177/0218492317751827

Cited by 4 publications

(8 citation statements)

References 7 publications

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“…With the help of infrared light, the lines among lung segments can be seen clearly. The target lung segments can be removed along the boundaries ( 31 ). The lung tissue is endoscopically placed in a sterile bag, removed from the chest cavity, and immediately sent for pathological evaluation.…”

Section: Resultsmentioning

confidence: 99%

“…Several bronchoscopic localization techniques have been advocated and validated in clinical trials, which overcome these adverse events associated with percutaneous needle marking ( 47 - 50 ). The endobronchial injection method offers relatively adequate visualization time for resecting the lung segment ( 31 ). In addition, describing the ISP of the lung with ICG is feasible despite the type of lung segmental anatomy, and is commonly utilized during lung segmentectomy ( 51 ).…”

Section: Resultsmentioning

confidence: 99%

“…Elkhouly et al explored segmental resection after endobronchial injection of ICG diluted to 10% in 3 patients. There were no reported side effects, and no recurrence occurred during the 12 and 15 months of follow-up, respectively ( 31 ). In a propensity-matched analysis, Sekine et al found that the short- and long-term outcomes of segmentectomy were similar between an ICG bronchoscopic injection group and an inflation-deflation method group ( 69 ).…”

Section: Discussionmentioning

confidence: 99%

“…The endobronchial injection method offers relatively adequate visualization time for resecting the lung segment (31). In addition, describing the ISP of the lung with ICG is feasible despite the type of lung segmental anatomy, and is commonly utilized during lung segmentectomy (51).…”

Section: Localization Of Pulmonary Lesions: Icg Injection Via Airway ...mentioning

confidence: 99%

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Expert consensus on indocyanine green fluorescence imaging for thoracoscopic lung resection (The Version 2022)

Cui¹,

Li²,

Du³

et al. 2022

Transl Lung Cancer Res

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The use of the white-light thoracoscopy is hampered by the low contrast between oncologic margins and surrounding normal parenchyma. As a result, many patients with in situ or micro-infiltrating adenocarcinoma have to undergo lobectomy due to a lack of tactile and visual feedback in the resection of solitary pulmonary nodules. Near-infrared (NIR) guided indocyanine green (ICG) fluorescence imaging technique has been widely investigated due to its unique capability in addressing the current challenges; however, there is no special consensus on the evidence and recommendations for its preoperative and intraoperative applications. This manuscript will describe the development process of a consensus on ICG fluorescence-guided thoracoscopic resection of pulmonary lesions and make recommendations that can be applied in a greater number of centers. Specifically, an expert panel of thoracic surgeons and radiographers was formed. Based on the quality of evidence and strength of recommendations, the consensus was developed in conjunction with the Chinese Guidelines on Video-assisted Thoracoscopy, and the National Comprehensive Cancer Network (NCCN) guidelines on the management of pulmonary lesions. Each of the statements was discussed and agreed upon with a unanimous consensus amongst the panel. A total of 6 consensus statements were developed. Fluorescence-guided thoracoscopy has unique advantages in the visualization of pulmonary nodules, and recognition and resection of the anterior plane of the pulmonary segment. The expert panel agrees that fluorescence-guided thoracoscopic surgery has the potential to become a routine operation for the treatment of pulmonary lesions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Localization Of Pulmonary Lesions: Icg Injection Via Airway ...mentioning

confidence: 99%

See 2 more Smart Citations

Expert consensus on indocyanine green fluorescence imaging for thoracoscopic lung resection (The Version 2022)

Cui¹,

Li²,

Du³

et al. 2022

Transl Lung Cancer Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…Sekine et al injected ICG (20 to 30 mL of 5-fold salinediluted ICG) into the target pulmonary segment through the trachea, and visualized the segmental plane through fluorescent thoracoscopy to accurately dissect the target segment (12). However, Elkhouly et al proposed that this method has certain defects (13). First, the ICG may return from the target bronchus to the bronchial tree, interfering with the identification of the segmental plane; second, injecting the ICG into bronchus of the target segment may cause the tumor cells to spread across the target segment to other segments.…”

Section: Precise Demarcation Of Segmental Planementioning

confidence: 99%

A narrative review of indocyanine green near-infrared fluorescence imaging technique: a new application in thoracic surgery

Wang¹,

Weng²,

Geng³

et al. 2021

Curr Chall Thorac Surg

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In clinical work of thoracic surgery, accurate anatomic location of pulmonary nodules, precise demarcation of segmental and sub-segmental plane, tracing of sentinel lymph nodes (SLNs), protection of thoracic nerve, averting of anastomotic fistula etc. always puzzling the surgeons. Indocyanine green (ICG) is a near-infrared fluorescence (NIRF) contrast agent that is the only reagent approved by the Food and Drug Administration (FDA) for use in human subjects due to its low toxicity and high absorbance in the near-infrared spectrum. The application of ICG NIRF imaging technology in surgery is safe and feasible, it can offer real-time fluorescing information and help surgeons make important decisions during surgery.Many studies demonstrated that ICG NIRF can be used to determine tissue perfusion, lymphatic reflux and other fields. In recent years, it has been reported in the field of thoracic surgery and got success. It can provide more information compared to conventional video-assisted thoracoscopic surgery (VATS). In this review, the research results of this technique in animal models and clinical trials in recent years are reviewed the application of ICG NIRF technique in accurate positioning of pulmonary nodules, precise demarcation of segmental and sub-segmental plane, SLNs tracing, thoracic nerve protection, anastomotic leakage and chylothorax prevention.

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How to identify intersegmental planes in performing sublobar anatomical resections

Nex¹,

Schiavone²,

Palma³

et al. 2020

J Thorac Dis

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Pulmonary segmentectomy is a common surgical procedure in thoracic surgery nowadays.Though this technique helps preventing postoperative pulmonary function loss, potential challenges are the management of air leaks and the difficulty of palpating ground-glass components during surgery, as well as how to deal with the intersegmental planes. Several techniques have been proposed for the identification and treatment of the intersegmental planes during sublobar anatomical resections: this review focuses on preoperative planning and workup and intraoperative strategies. Three-dimensional computed tomography bronchography and angiography (3D-CTBA), virtual-assisted mapping (VAL-MAP) using bronchoscopy multi-spot dye marking and three-dimensional computed tomography (3D-CT) are preoperative tools that may facilitate the planning of operation. Inflation-deflation techniques, infrared-fluorescence-enhanced method combined with bronchial and intravenous injection of indocyanine green (ICG) and near-infrared fluorescence (NIF) mapping with ICG have been described as intraoperative strategies to identify the intersegmental plane. The treatment and section of the intersegmental planes is mainly accomplished by stapler and electrocautery or energy devices. The use of staplers reduces postoperative air leaks, bleeding risks and operative time but seems to reduce preserved lung volume, compromising adjacent lung expansion; in addition, higher costs and sometimes non-adequate oncological margins, being a non-anatomical technique have been described. The electrocautery and energy devices allow for a more anatomical and precise dissection maintaining safe oncological margins, with a better lung expansion and so an increased postoperative lung function. Time consuming procedure and frequent requirement of aero-haemostatic tools to treat air and blood leaks are the main drawbacks. In conclusion, there are several methods to identify and treat the intersegmental planes but there are no significant differences between the different tools, therefore the use of one technique rather than another depends overall on surgeon's preference and the location of the segment.

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A new method of infrared-fluorescence-enhanced thoracoscopic segmentectomy

Cited by 4 publications

References 7 publications

Expert consensus on indocyanine green fluorescence imaging for thoracoscopic lung resection (The Version 2022)

Expert consensus on indocyanine green fluorescence imaging for thoracoscopic lung resection (The Version 2022)

A narrative review of indocyanine green near-infrared fluorescence imaging technique: a new application in thoracic surgery

How to identify intersegmental planes in performing sublobar anatomical resections

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