Near-Infrared–Guided Pulmonary Segmentectomy After Endobronchial Indocyanine Green Injection

Abstract

Background. The aim of this study is to prospectively determine the feasibility and safety of near-infrared fluorescence-guided pulmonary segmentectomy after endobronchial indocyanine green (ICG) injection using virtual bronchoscopy.Methods. Fifteen patients who underwent pulmonary segmentectomy were prospectively enrolled. Using preoperative computed tomography datasets a bronchial road map was created to determine the bronchus for ICG injection. Immediately after intubation ICG was injected into the target bronchi using an ultrathin bronchoscope. During the operation a near-infrared thoracoscope was used to detect ICG fluorescence and determine the intersegmental plane. The assessment points were (1) whether the ICG demarcation lines corresponded to the intersegmental lines expected from the pulmonary veins, (2) whether it was possible for the planned segmentectomy to be completed by electrocautery and 1 or fewer uses of an automated suturing device according to the demarcation plane, (3) whether any surgical complications occurred intraoperatively or (4) in the 1 month after surgery, and (5) whether the target lesion was removed completely with sufficient surgical margin to evaluate the feasibility and safety of this procedure.Results. In 13 cases (87%) a segmentectomy was completed in the planned way with sufficient surgical margins. The failure in 2 cases was due to a technical issue in the bronchial injection. No complications developed intraoperatively. Recurrent air leakage occurred in 1 case. No procedure-related adverse event was noted postoperatively.Conclusions. Near-infrared-guided pulmonary segmentectomy with endobronchial ICG injection using virtual bronchoscopy was safe and feasible, and minor technical revision can make this procedure more reliable.

Novel thoracoscopic segmentectomy combining preoperative three-dimensional image simulation and intravenous administration of indocyanine green

“…Jet ventilation, in which the segment to be resected is selectively inflated, was reported by Okada et al [ 13 ]; it enables different segments to be rapidly and easily identified by inflating only the segment to be resected, but it requires the participation of an anesthesiologist and familiarity with the procedure. Transbronchial ICG administration has a similarly high reported success rate, but in addition to the proficiency required to perform bronchoscopy procedures and the danger of splashing neighbouring segments, the fact that this is an off-label procedure is also an issue [ 16 , 17 ].…”

Left subsuperior segmentectomy for a patient with early-stage lung cancer: a case report

“…Since this left S* segmentectomy has multiple segmental planes between the S6 and basal segment, selective ventilation via bronchoscopy is effective and useful. We previously reported near-infrared-guided pulmonary segmentectomy after endobronchial indocyanine green (ICG) injection [9]. ICG injection via the bronchus or intravenous technique is useful in S* segmentectomy.…”

Scope of Real Time Fluorescence Imaging in Esophagectomy

“…Thoracic surgeons have utilized ICG for determining the intersegmental plane in lung segmentectomies [33]. While intravenous ICG injection was studied initially, subsequently endobronchial injection has also been successfully attempted [34]. The authors have applied the same principle by performing nebulization of ICG for early visualization and accurate dissection of posterior membrane of trachea and bronchus in difficult tumors.…”