New clinically applicable method for visualizing adjacent lung segments using an infrared thoracoscopy system

Misaki, Noriyuki; Chang, Sung Soo; Igai, Hitoshi; Tarumi, Shintaro; Gotoh, Masashi; Yokomise, Hiroyasu

doi:10.1016/j.jtcvs.2010.07.020

Cited by 142 publications

(125 citation statements)

References 12 publications

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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: Resultsmentioning

confidence: 75%

“…In their study, the dominant pulmonary artery of the target segment (TS) was ligated, and after injection of ICG, infrared thoracoscopy revealed ICGF. Their detailed macroscopic and microscopic study confirmed that the demarcation corresponded to the intersegmental line (7,8).…”

Section: Summary Of Icg Fluorescencementioning

confidence: 79%

“…In addition, the inflated lung occasionally obstructs the surgical view during thoracoscopic surgery (TS). Indocyanine green fluorescence (ICGF) has been reported to identify the intersegmental plane without lung inflation (7,8). This report describes our initial experience of 3D-CT imaging and ICGF-navigated thoracoscopic anatomical segmentectomy (TS-S).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 75%

Section: Summary Of Icg Fluorescencementioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

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Indocyanine green fluorescence-navigated thoracoscopic anatomical segmentectomy

Mun¹,

Okumura²,

Nakao³

et al. 2017

J. Vis. Surg.

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“…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.…”

Section: Original Articlementioning

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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“…In the latter cases, depiction of the inflation-deflation line is difficult when air is poorly sent from the segmental bronchus planned for resection. Problems encountered in cases of emphysema include: (I) inaccurate border due to communication with the resected segments arising from peripheral lung destruction; and (II) difficulty in inducing collapse due to air trapping.Aside from the air-sending method for visualizing the intersegmental plane, other methods are available, including a method involving injection of indocyanine green (ICG) into the segmental bronchus planned for resection (20,21) and a method in which the intersegmental line is observed under an infrared thoracoscope after intravenous injection of ICG following pulmonary artery blocking (22,23). The method involving ICG injection into the bronchus involves the risk for failure to achieve uniform dispersion of the dye in subsegments.…”

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confidence: 99%

How to demarcate intersegmental plane with resected-segments inflation method using the slip knot technique in thoracoscopic anatomic segmentectomy

et al. 2017

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Intersegmental demarcation line on the surface of the visceral pleura could not be found at thoracoscopic findings. The resected segments inflation (RSI) method has been reported as a useful technique for visualizing the intersegmental demarcation line during segmentectomy. Thoracoscopic anatomic segmentectomy is performed as follows: firstly, the pulmonary vein and artery of the segment planned for resection are dissected from the hilum in order to isolate the segmental bronchus located behind the pulmonary artery. Secondly, a monofilament non-absorbable suture is passed through the segmental bronchus, and a slip-knot is made outside the thorax. Thirdly, bilateral lung ventilation with pure oxygen is conducted. When the affected segment has inflated sufficiently, the slip knot suture is pulled and the segmental bronchus is ligated and collapse of the lung is made on reserved segments. Fourthly, as inflation of the affected segment and collapse of the reserved segments could be found, resection of intersegmental plane could be easily performed with the inflation-deflation line and the intersegmental pulmonary vein. If resected segmental bronchus could be identified, thoracoscopic segmentectomy with the slip-knot technique would be applicable. This slip-knot procedure is economical and is not need special instrument. RSI methodAir is sent to the objective segmental bronchus located at the center of the basic pulmonary structure. The affected segment is inflated and reserved segments are collapsed and an intersegmental plane could be identified. If this is visualized well, resection of intersegmental plane could be easily performed with the inflation-deflation line and the intersegmental pulmonary vein. The lung parenchyma that is undergoing dissection of the intersegmental plane shows changes of the color by containing the air, which serves as a landmark during dissection. This method is advantageous in that inflated segments enable identify the surgical margin from the tumor to the intersegmental plane in an air-filled condition (6).Several methods for sending air to the resected segments have been reported. They include the jet ventilation method (7,8), and the butterfly needle method (9,10). The butterfly needle method involves the risk of an air embolism due to possible entry of air into the vein neighboring the bronchus (11,12). In this paper, we demonstrated that a new slip knot technique to make intersegmental demarcation line during segentectomy. Slip knot techniqueWe have been using the RSI method to identify the intersegmental plane. In the past, bronchoscopy was used to send air to the objective bronchus. However, this technique is skillful and the inflated segments become an obstacle to perform a thoracoscopic procedure in narrow intrathoracic space. To resolve the problems, we developed the slip knot technique, and use this technique to perform thoracoscopic anatomic segmentectomy.The modified Roeder knot is a method of ligation that is employed for the slip knot technique (13). A 3-0 or 4...

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New clinically applicable method for visualizing adjacent lung segments using an infrared thoracoscopy system

Cited by 142 publications

References 12 publications

Indocyanine green fluorescence-navigated thoracoscopic anatomical segmentectomy

Indocyanine green fluorescence-navigated thoracoscopic anatomical segmentectomy

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

How to demarcate intersegmental plane with resected-segments inflation method using the slip knot technique in thoracoscopic anatomic segmentectomy

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