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

Mao, Yamin; He, Kunshan; Ye, Jinzuo; Yang, Fan; Zhou, Jian; Li, Hao; Chen, Xiuyuan; Wang, Jun; Chi, Chongwei; Hui, Hui

doi:10.1117/1.jbo.22.6.066002

Cited by 13 publications

(6 citation statements)

References 37 publications

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“…In addition to the ergonomic improvements compared to our previous system 27 , the novel system used a custom prism with a 30° viewing angle. The use of this prism not only made probing the thoracic sympathetic nerve more convenient, but also resulted in a large aperture and a wide field.…”

Section: Methodsmentioning

confidence: 99%

Near-infrared Intraoperative Imaging of Thoracic Sympathetic Nerves: From Preclinical Study to Clinical Trial

Zhou

Yang

et al. 2018

Theranostics

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The sympathetic nervous system controls and regulates the activities of the heart and other organs. Sympathetic nervous system dysfunction leads to disease. Therefore, intraoperative real-time imaging of thoracic sympathetic nerves (ITSN) would be of great clinical significance for diagnosis and therapy. The aim of this experimental study was to evaluate the feasibility and validity of intraoperative ITSN using indocyanine green (ICG).Methods: ITSN using ICG was performed on 10 rabbits to determine its feasibility. Animals were allocated to two groups. The rabbits in one group received the same dose of ICG, but were observed at different times. The rabbits in the other group were administered different doses of ICG, but were observed at the same time. Signal to background ratio (SBR) was measured in regions of interest in all rabbits. Furthermore, fifteen consecutive patients with pulmonary nodules were intravenously injected with ICG 24 h preoperatively and underwent near-infrared (NIR) fluorescence imaging (FI) thoracoscopic surgeries between July 2015 and June 2016. A novel self-developed NIR and white-light dual-channel thoracoscope system was used. SBRs of thoracic sympathetic nerves were calculated in all patients.Results: In the preclinical study, we were able to precisely recognize each rabbit's second (T2) to fifth (T5) thoracic ganglia on both sides of the spine using ITSN with ICG. In addition, we explored the relationship between SBR and the injection time of ICG and that between SBR and the dose of ICG. Using the novel dual-channel thoracoscope system, we were able to locate the ganglia from the stellate ganglion (SG) to the sixth thoracic ganglion (T6), as well as the chains between these ganglia in all patients with a high SBR value of 3.26 (standard deviation: 0.57). The pathological results confirmed our findings.Conclusion: We were able to use ICG FI to distinguish thoracic sympathetic nerves during NIR thoracoscopic surgery. The technique may replace the rib-oriented method as standard practice for mapping the thoracic sympathetic nerves.

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Section: Methodsmentioning

confidence: 99%

Near-infrared Intraoperative Imaging of Thoracic Sympathetic Nerves: From Preclinical Study to Clinical Trial

Zhou

Yang

et al. 2018

Theranostics

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“…The type and stage of lung cancer to formulate corresponding treatment measures are necessary to evaluate, such as surgical resection, radiotherapy, or concurrent radiochemotherapy. For patients with advanced lung cancer or patients prone to remote metastasis, radiotherapy, immunotherapy, or a combination of multiple methods may be required [ 12 , 13 ]. Early lung cancer can be eradicated by surgical resection of tumor tissue and its surrounding tissues.…”

Section: Introductionmentioning

confidence: 99%

Nomogram Prediction Model Analysis of Risk Factors for Conversion to Thoracotomy after Thoracoscopic Resection of Lung Cancer and Prognostic Value of Lung Cancer

Zhu

et al. 2022

Computational and Mathematical Methods in Medicine

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This study was aimed at exploring the risk factors for thoracotomy in patients undergoing thoracoscopic resection of lung cancer and further analyzing the factors affecting the prognosis of patients. Ninety-six patients with non-small-cell lung cancer who underwent thoracoscopic pulmonary resection were recruited as the subjects, and they were enrolled into the thoracoscopic group ( n = 88 ) and the thoracotomy group ( n = 8 ) according to whether thoracotomy was performed. Univariate analysis and logistic multivariate regression were performed to analyze the risk factors for conversion to thoracotomy, and nomogram prediction model was employed to analyze the prognostic factors. The results revealed that the proportion of patients over 65 years old, with history of coronary heart disease, diabetes, and pulmonary tuberculosis, etc., in the thoracotomy group and the thoracoscopic group was significantly different ( P < 0.05 ). There were statistically significant differences in the development of interlobular cleft, pleural adhesion, tumor diameter > 3.5 cm, vascular and lymph node invasion, and tumor TNM stage between the thoracotomy group and the thoracoscopic group ( P < 0.05 ). Overall, the age of patients ≥ 65 years old, tumor diameter > 3.5 cm, hypoplasia of interlobular fissure, history of pulmonary tuberculosis, pleural adhesion, and TNM stage IIIa were all independent risk factors for thoracoscopic resection of lung cancer to thoracotomy. Cox model and nomogram prediction model analysis showed that surgery methods, tumor diameter > 3.5 cm, chemotherapy cycle < 4 , chemotherapy, and TNM stage IIIa were all independent factors influencing the prognosis of patients undergoing thoracoscopic lung cancer resection. This nomogram prediction model had high application value in patient prognosis prediction.

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“…Furthermore, ICG localized areas in patients with lung anthracosis are better visualized compared to IC or MB ( 55 , 62 ). NIR imaging systems have been developed in order to detect the fluorescent dyes and aid thoracic surgeons intra-operatively in accurately detecting the localized lung nodules ( 63 ). This is perceived as a drawback for ICG because it requires specialized NIR equipment to identify the localized area.…”

Section: Discussionmentioning

confidence: 99%

How effective is indocyanine green (ICG) in localization of malignant pulmonary nodules? A systematic review and meta-analysis

et al. 2022

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BackgroundVideo-Assisted and Robotic-Assisted techniques become constantly more prominent practice in thoracic surgery for lung cancer. Furthermore, the increased frequency in detection of small lung cancers makes the intra-operative identification of these cancers even more challenging. Indocyanine Green (ICG) is one of the most commonly used dyes that assists surgeons identify small lung cancers intra-operatively. Our study aimed to evaluate the effectiveness and safety of ICG in lung cancer detection.MethodsWe performed a systematic review of the literature by screening the databases of MEDLINE, EMBASE, CENTRAL and Scopus until 30th April 2022 and the first 300 articles of Google Scholar for any suitable grey literature. We included any study that investigated the effectiveness of ICG in lung cancer detection. We excluded studies that explored the use of ICG only in identification of intersegmental planes, lymph node mapping, case reports and non-English articles. We aimed to perform a meta-analysis on test accuracy studies using hierarchical summary receiver operating characteristic (HSROC) and the bivariate random-effects models. In cases where the data for a localization technique was not sufficient for that analysis, it was presented with tables with narrative purposes. Each study was assessed for Risk of Bias (RoB) and Applicability using the QUADAS-2 tool.ResultsWe found 30 eligible studies that included a total of 1,776 patients who underwent ICG localization of pulmonary nodules. We identified three ICG localization techniques: CT-guided, endobronchial and intravenous. From the 30 studies, 13 investigated CT-guided localization, 12 explored an endobronchial method while 8 studies administered ICG intravenously the median reported success rate was 94.3% (IQR: 91.4%–100%) and 98.3% (IQR: 94%–100%) for the first two techniques respectively. Intravenous ICG lung cancer localization showed Sensitivity of 88% (95% CI: 59%–0.97%) and Specificity of 25% (95% CI: 0.04%–0.74%). There were 15.2% (150/989) patients who experienced complications from CT guided ICG localization. No ICG-related complications were reported in endobronchial or intravenous techniques.ConclusionOur study provides a comprehensive review of the literature on ICG localization techniques for lung cancer. Current evidence suggests that ICG is boh effective and safe. Further prospective research with standardized protocols across multiple thoracic units is required in order to accurately validate these findings.

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

Cited by 13 publications

References 37 publications

Near-infrared Intraoperative Imaging of Thoracic Sympathetic Nerves: From Preclinical Study to Clinical Trial

Near-infrared Intraoperative Imaging of Thoracic Sympathetic Nerves: From Preclinical Study to Clinical Trial

Nomogram Prediction Model Analysis of Risk Factors for Conversion to Thoracotomy after Thoracoscopic Resection of Lung Cancer and Prognostic Value of Lung Cancer

How effective is indocyanine green (ICG) in localization of malignant pulmonary nodules? A systematic review and meta-analysis

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