Clinical trial of video-assisted thoracoscopic segmentectomy using infrared thoracoscopy with indocyanine green

Tarumi, Shintaro; Misaki, Noriyuki; Kasai, Yoshitaka; Chang, Sung Soo; Go, Tetsuhiko; Yokomise, Hiroyasu

doi:10.1093/ejcts/ezt565

Cited by 92 publications

(97 citation statements)

References 19 publications

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“…In our study, the ISP was not accurately identified in 12% of patients. This result is quite similar to that of Tarumi et al (15%) (9). The collateral vascularization between the pulmonary and bronchial circulation could explain this result.…”

Section: Discussionsupporting

confidence: 92%

“…Nevertheless, the surgeon needs intraoperative assistance to identify the ISP. As previously described, near-infrared angiography with indocyanine green (ICG) can be helpful in the identification of the ISP during VATS (7)(8)(9). In contrast to bronchial segmentation, vascular segmentation with ICG is easier and can enable precise anatomical resection.…”

Section: Introductionmentioning

confidence: 99%

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Impact of near-infrared angiography on the quality of anatomical resection during video-assisted thoracic surgery segmentectomy

et al. 2018

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Background:The aim of the present study was to assess the impact of near-infrared angiography in guiding intraoperatively sublobar anatomical resection by video-assisted thoracic surgery (VATS). Methods: We retrospectively analyzed data from 67 patients who underwent segmentectomy by VATS from November 2014 to November 2017 at the University Hospitals of Geneva, Switzerland. The need to modify arterial or parenchymal resection based on intraoperative near-infrared imaging was considered the primary study outcome. Results: A total of 67 patients (28 men, 39 women, mean age 66±10 years) underwent anatomical pulmonary segmentectomy by VATS. Histological analysis revealed a primary lung tumor in 59 patients. The mean ± standard deviation (SD) operation time was 154±51 minutes. Identification of the intersegmental plane (ISP) with near-infrared angiography was achieved in 88% of patients and led to modification of the resection during segmentectomy in 7 patients (10%), avoiding inappropriate resection; 2 patients had distant tumor recurrences (3%). Conclusions: Near-infrared angiography during VATS segmentectomy is effective for identifying ISPs, with respect to the oncological margins, as well as for correcting the anatomical resection.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Impact of near-infrared angiography on the quality of anatomical resection during video-assisted thoracic surgery segmentectomy

et al. 2018

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“…According to other toxicity studies, intravenous injection of up to 5.0 mg/kg ICG is quite safe and acceptable (9). In the present study, the sensitivity of this ICG system was better than that of previous reports, so we were able to create ICGF images twice in one operation (8,10). For example, when we performed right segments (S)9+10 segmentectomy, we first divided the intersegmental line between S6 and the basal segments along the ICGF demarcation after clamping the pulmonary artery of S6.…”

Section: Discussionmentioning

confidence: 76%

Indocyanine green fluorescence-navigated thoracoscopic anatomical segmentectomy

Mun¹,

Okumura²,

Nakao³

et al. 2017

J. Vis. Surg.

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Background: To evaluate the feasibility and efficacy of thoracoscopic anatomical segmentectomy (TS-S) using three-dimensional computed tomography (3D-CT) reconstruction and indocyanine green-fluorescence (ICGF) navigation.Methods: Twenty TS-S procedures were performed for 15 primary lung cancers and 5 metastatic lung tumors. Preoperatively we evaluated the target segmental pulmonary artery and created a virtual intersegmental plane using 3D-CT reconstruction. Intraoperatively, the target segmental artery and bronchus were divided, and after intravenous systemic injection of indocyanine green (ICG, 0.25 mg/kg), ICGF of the non-target segments (NTS) was observed using infrared thoracoscopy (KARL STORZ Endoskope Japan K.K., Tokyo, Japan). We marked the border between target and NTS with electrocautery and divided the lung parenchyma along this border using electrocautery or staples.Strength of contrast between target and NTS was quantified as contrast index (CI) and compared over time.Results: ICGF provided demarcation of sufficient clarity and duration to mark the lung surface in 19 patients (95%). TS-S was successfully performed in all patients. Mean operative duration was 186 min (90-310 min) and mean blood loss was 30 mL (0-107 mL). Demarcation appeared 20 s (10-100 s) after injection of ICG, and ICGF lasted 180 s (90-300 s). CI peaked 30 s after the appearance of ICGF and decreased over time. Effective contrast continued for 70 s (30-116 s), which was sufficient to mark the line of demarcation. There were no complications attributable to this method.Conclusions: ICGF navigation is a safe and effective technique for TS-S.

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“…In 2010, Misaki et al observed a welldefined color zonation in all patients (n=8) who underwent thoracotomy and discussed that they have developed a new clinically applicable method for visualizing adjacent lung segments based on blood supply and with the use of ICG with infrared thoracoscopy (5). They expanded this technique to 44 patients (thoracotomy in 31 and videoassisted TS or VATS in 13) (8). In 2014, Tarumi et al additionally used infrared thoracoscopy with ICG during VATS segmentectomy and reported that the identification of the intersegmental line based on blood flow differences was possible in 11/13 (84.6%) patients after the dissection of hilar structures (8).…”

Section: Discussionmentioning

confidence: 99%

“…They expanded this technique to 44 patients (thoracotomy in 31 and videoassisted TS or VATS in 13) (8). In 2014, Tarumi et al additionally used infrared thoracoscopy with ICG during VATS segmentectomy and reported that the identification of the intersegmental line based on blood flow differences was possible in 11/13 (84.6%) patients after the dissection of hilar structures (8). In another study in 2013, Kasai et al observed that infrared thoracoscopy with ICG by 1-or 2-wavelength methods was useful for detecting the intersegmental line, facilitating anatomical segmentectomy in 30 consecutive patients (9).…”

Section: Discussionmentioning

confidence: 99%

Predictors of indocyanine green visualization during fluorescence imaging for segmental plane formation in thoracoscopic anatomical segmentectomy

Iizuka¹,

Kuroda²,

Yoshimura³

et al. 2016

J. Thorac. Dis.

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Background: To determine factors predicting indocyanine green (ICG) visualization during fluorescence imaging for segmental plane formation in thoracoscopic anatomical segmentectomy.Methods: Intraoperatively, the intravenous ICG fluorescence imaging system during thoracoscopic anatomical segmentectomy obtained fluorescence emitted images of its surfaces during lung segmental plane formation after the administration of 5 mg/body weight of ICG. The subtraction of regularization scale for calculating the exciting peaks of ICG between the planned segments to resect and to remain was defined as ΔIntensity (ΔI). Variables such as the ratio of forced expiratory volume in 1 s to forced vital capacity (%FEV 1.0 ), smoking index (SI), body mass index (BMI), and low attenuation area (LAA) on computed tomography (CT) took a leading part.Results: The formation of the segmental plane was successfully accomplished in 98.6% segments and/or subsegments. SI and LAA significantly affected ΔI levels. The area under the receiver operating characteristic curve for the %FEV 1.0 , SI, and LAA was 0.56, 0.70, and 0.74, respectively. SI >800 and LAA >1.0% were strong predictors of unfavorable ICG visibility (P=0.04 and 0.01, respectively).Conclusions: Fluorescence imaging with ICG was a safe and effective method for segmental plane formation during thoracoscopic anatomical segmentectomy. In spite of its high success rate, unfavorable visibility may potentially occur in patients who are heavy smokers or those with a LAA (>1.0%) on CT. margin. Misunderstanding of anatomical structures may cause unnecessary bleeding or postoperative air leakage and inadequate resection of a non-palpable tumor in the remaining lobe. Several methods to identify the lung demarcation line have been reported (3,4). Intriguingly, methods based on lung ventilation frequently require that the intersegmental plane be approached along the inflation-deflation (ID) line at the peripheral site, while the intersegmental vein serves as a landmark at the central portion around the hilum. The ID lines, also known as segmental lines, sometimes overlap due to the existence of the pores of Kohn at the lung periphery. For methods that use the ID line to detect the segmental plane, the degree of difficulty becomes higher in patients with emphysematous lung. In such a case, the surgeons' experience and skills are required, particularly in thoracoscopic surgery (TS).The technique of visualizing the demarcation line based on fluorescence imaging with indocyanine green (ICG) during thoracotomy or thoracoscopy was recently developed and used by surgeons, with relatively high success rates (3,5). From our experiences during anatomical segmentectomy by TS, we noticed that ICG brightness varied in every case, depending on the blood flow or presence of anthracosis; therefore, there is a doubt on the accuracy of ICG fluorescence imaging in demarcating the segmental plane. The ICG visualization tended to be hard in patients with heavy anthracosis compared with those with light-to-middle an...

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Clinical trial of video-assisted thoracoscopic segmentectomy using infrared thoracoscopy with indocyanine green

Abstract: VATS segmentectomy using IRT with ICG allows the maintenance of a clear surgical view and identification of the intersegmental line in a high proportion of cases. Therefore, we consider this method to be useful for minimally invasive thoracic surgery.

Cited by 92 publications

References 19 publications

Impact of near-infrared angiography on the quality of anatomical resection during video-assisted thoracic surgery segmentectomy

Impact of near-infrared angiography on the quality of anatomical resection during video-assisted thoracic surgery segmentectomy

Indocyanine green fluorescence-navigated thoracoscopic anatomical segmentectomy

Predictors of indocyanine green visualization during fluorescence imaging for segmental plane formation in thoracoscopic anatomical segmentectomy

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