A novel fluorescence technique for identification of the pulmonary segments by using the photodynamic diagnosis endoscope system: An experimental study in ex vivo porcine lung

Waseda, Ryuichi; Oda, Makoto; Matsumoto, Isao; Takizawa, Masaomi; Suzuki, M; Ohsima, Masahiro; Watanabe, Go

doi:10.1016/j.jtcvs.2012.09.010

Cited by 11 publications

(8 citation statements)

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“…These techniques enable the identification of the boundary line without lung infiltration and provide a stable working section capable of continuing the process of surgery, TS in particular, while ensuring a sufficient working space. However, Waseda et al described that the latter method was not applicable to complicated segmentectomies because the duration of intravascular ICG visualization was too short and a large amount of ICG was ideally required (12). How much is an appropriate amount of ICG for TS segmentectomy?…”

Section: Discussionmentioning

confidence: 99%

A new LigaSure technique for the formation of segmental plane by intravenous indocyanine green fluorescence during thoracoscopic anatomical segmentectomy

et al. 2016

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Background: The purpose of this study was to present a new approach to the formation of a segmental plane by LigaSure (Covidien, Mansfield, MA, USA) with indocyanine green (ICG) fluorescence system during thoracoscopic segmentectomy. Methods: This was a consecutive study that compared 12 patients who underwent a new LigaSure technique (LT) for segmental plane formation during thoracoscopic anatomical segmentectomy with 38 patients who underwent conventional methods using the staple technique (ST). Eleven patients were followed up more than 3 months after discharge. Results: The mean age of the patients was 66 years in the LT group and 67 years in ST. The mean duration for the formation of segmental plane and the mean number of staples was 22.8 min and 1.8 per surgery, respectively, in the LT group; and 16.2 min and 3.4 per surgery, respectively, in ST. No patient had a prolonged air leak (PAL) of more than 7 days. Minor air leak was identified early in two and was delayed in one. Two-thirds of patients with early minor air leak had low index of prolonged air leak (IPAL) score. There was no air leak in the patients with high IPAL score. Eventually, we deduced that the cause of the minor air leak was a technical problem. Conclusions: In the formation of segmental plane during thoracoscopic segmentectomy, a combination of ICG fluorescence and LigaSure may be beneficial for patients. As a new operative instrument, LT constitutes, in our opinion, a feasible and easy alternative to other thoracoscopic techniques. J Thorac Dis 2016;8(6):1210-1216 jtd.amegroups.com more often than TS. During TS, it is important to proceed with the operation with a clear anatomical understanding (4,5).In order to solve this problem, we used LigaSure under indocyanine green (ICG) fluorescence system to delineate the anatomical segmental plane during TS. The LigaSure is a technique that has been widely used in pulmonary resection (6); the purpose of this study was to assess its efficacy and safety for segmental plane formation. MethodsThis was a study on consecutive patients who underwent anatomical segmentectomy using ICG fluorescence system (Karl Storz, Tuttlingen, Germany) at Aichi Cancer Center Hospital between June 2013 and December 2014. Total 60 consecutive various bilateral segmentectomies using this device were performed or supervised by more than two senior consultants who have the experience of doing more than 200 procedures (Table 1). In all cases, informed consent for the procedure was obtained. ICG was intravenously administered at 2 mL/body ICG (one fifth of the usual amount in hepatic function test). Patients were scheduled for outpatient control after 3 to 6 months and postoperative follow-up for complications was conducted at a median of 10 months (range, 3-18 months). For postoperative air leak, the term "minor" was defined as no requirement for drainage; the period after removal of tube drainage was defined as "early" when it was performed prior to hospital discharge and as "delayed" when it was performed on outpatient ...

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Section: Discussionmentioning

confidence: 99%

A new LigaSure technique for the formation of segmental plane by intravenous indocyanine green fluorescence during thoracoscopic anatomical segmentectomy

et al. 2016

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“…Although rare, the hook wire localization method is associated with air embolism, which can be lethal (3). Given that vitamin B2 is harmless to the body and is fluorescent, we have reported various methods to apply it to thoracic surgery (4)(5)(6). In this study, we aimed to establish a facile and safe lung-marking method and proposed a novel lung-marking method of injecting a vitamin B2 aqueous solution under the visceral pleura.…”

Section: Original Articlementioning

confidence: 99%

Vitamin B2 lung-marking method using black light irradiation

et al. 2020

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Background: Various approaches and markers for marking the lungs prior to lung tumor resection have been reported. In clinical practice, the hook wire localization method is often used owing to the simplicity of the technique. However, although rare, this method is associated with air embolism, which can be lethal. Because vitamin B2 is harmless to the body and fluorescent, it was applied to various methods for thoracic surgery. Using a pig model, we aimed to examine whether a lung-marking method involving the injection of vitamin B2 to peripheral small lung lesions and observing them under black light irradiation could replace the hook wire localization method. Methods: We used a pig model to perform hook wire localization of the lungs and at the same time injected 1 mL of a vitamin B2 aqueous solution to the lung parenchyma at the hook wire puncture site under the visceral pleura. Subsequently, we measured the length of the fluorescent marked area and fluorescence intensity over time. Black light was used to assess the fluorescent marked area, and fluorescence intensity was quantified using image analysis software.Results: Lung-marking was successful in all five pigs and we visualized the vitamin B2-marked area under black light irradiation. Measurements were taken immediately after thoracotomy (0 min) and 60 and 120 min thereafter. No changes in the length of the marked area (1.3±0.3/1.2±0.3/1.1±0.3 cm, 0/60/120 min, P=0.21) and fluorescence intensity (162.8±55.1/157.2±63.1/165.2±62.2, 0/60/120 min, P=0.96) were observed over time. Compared to the non-marked area (normal lungs), the marked area showed significantly higher fluorescence intensity (P=0.01/0.01/0.01, 0/60/120 min).Conclusions: Vitamin B2 lung-marking was performed safely and accurately using the pig model, providing good visibility of the marked area. This approach may replace the hook wire localization method.In the near future, we plan to conduct clinical trials to evaluate the applicability of this method in humans.

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“…We measured the optical resolution of FFWT at different distances (25,50, and 75 mm), which were shown in Figs. 4(a)-4(d).…”

Section: Optical Resolutionmentioning

confidence: 99%

“…22 Furthermore, NIR fluorescence imaging also showed its potential in minimally invasive lung cancer surgery (MILCS). 13,[23][24][25] Vivek et al successfully detected lung sentinel lymph node with a self-developed fluorescence endoscopic system. 13 However, the optimization of the endoscopic NIR imaging system in sensitivity and ergonomic clinic design for improving MILCS in clinical practices remains extremely underexplored.…”

Section: Introductionmentioning

confidence: 99%

“…Although some researchers have applied the ICG-fluorescent imaging technique in segmentectomy, they used a single-camera fluorescence thoracoscope, which is inconvenient to acquire color and NIR images sequentially. [23][24][25]36 Sekine et al 37 designed a color and NIR dual-channel imaging system applying for open segmentectomy. However, the dualchannel imaging system has not been tested in the thoracoscopic segmentectomy.…”

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confidence: 99%

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Development and application of the near-infrared and white-light thoracoscope system for minimally invasive lung cancer surgery

Mao

et al. 2017

J. Biomed. Opt.

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In minimally invasive surgery, the white-light thoracoscope as a standard imaging tool is facing challenges of the low contrast between important anatomical or pathological regions and surrounding tissues. Recently, the near-infrared (NIR) fluorescence imaging shows superior advantages over the conventional white-light observation, which inspires researchers to develop imaging systems to improve overall outcomes of endoscopic imaging. We developed an NIR and white-light dual-channel thoracoscope system, which achieved high-fluorescent signal acquisition efficiency and the simultaneously optimal visualization of the NIR and color dual-channel signals. The system was designed to have fast and accurate image registration and high signal-to-background ratio by optimizing both software algorithms and optical hardware components for better performance in the NIR spectrum band. The system evaluation demonstrated that the minimally detectable concentration of indocyanine green (ICG) was 0.01 ?? ? M , and the spatial resolution was 35 ?? ? m . The in vivo feasibility of our system was verified by the preclinical experiments using six porcine models with the intravenous injection of ICG. Furthermore, the system was successfully applied for guiding the minimally invasive segmentectomy in three lung cancer patients, which revealed that our system held great promise for the clinical translation in lung cancer surgeries.

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A novel fluorescence technique for identification of the pulmonary segments by using the photodynamic diagnosis endoscope system: An experimental study in ex vivo porcine lung

Abstract: This florescence technique using vitamin B2 and the photodynamic diagnosis endoscope system is useful to identify the target pulmonary segment easily and clearly in ex vivo porcine lung.

Cited by 11 publications

References 11 publications

A new LigaSure technique for the formation of segmental plane by intravenous indocyanine green fluorescence during thoracoscopic anatomical segmentectomy

A new LigaSure technique for the formation of segmental plane by intravenous indocyanine green fluorescence during thoracoscopic anatomical segmentectomy

Vitamin B2 lung-marking method using black light irradiation

Development and application of the near-infrared and white-light thoracoscope system for minimally invasive lung cancer surgery

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