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

Abstract

OBJECTIVES The aim of this study is to assess prospectively the validity and feasibility of segmentectomy using preoperative simulation and intravenous indocyanine green (ICG) with near-infrared (NIR) light thoracoscope to ensure a sufficient surgical margin. METHODS This study was a prospective, single-centre, phase II, feasibility study. From February to July 2021, 20 patients were enrolled in this study. All patients underwent preoperative three-dimensional computed tomography angiography and bronchography using simulation software. The dominant pulmonary artery of the targeted segment was selected to determine the dissection line and measure the surgical margin to the tumour. Intraoperatively, after the planned dissection of the pulmonary artery, ICG (0.3 mg/kg) was administered intravenously and observed with NIR, and dissection was performed along the line determined by preoperative simulation. Postoperatively, the pathological margin was compared with the simulation margin. RESULTS All surgeries were performed via an uniport (3.5–4.0-cm skin incision). The regions of segmentectomy were S2, S3, S6, S9 + 10 and S10 of the right side and S1 + 2 + 3, S3, S3 + 4 + 5, S6 and S8 of the left side. The difference between the simulation margin and the pathological margin was not significant (simulation 30.5 ± 10.1 vs pathological 31.0 ± 11.0 mm, P = 0.801). The simulation margin was well correlated with the pathological margin (R2 = 0.677). The proportion of cases successfully achieving the pathological margin of error of plus or minus 10 mm of the simulation margin was 90% (18 of 20 cases). CONCLUSIONS The combination of preoperative three-dimensional computed tomography simulation and ICG–NIR was effective for securing a sufficient margin in segmentectomy.

Impact of indocyanine green on prolonged air leak in minimally invasive segmentectomy

“…Another reason to evaluate accurate identification of the ISP is to ensure healthy and adequate histological margins. Three studies have previously investigated the effect of ICG on pathological outcomes 5,11,12 . Mehta et al examined the distance between the tumor and the parenchymal plane of section, first marked by the surgeon and second visualized after injection of the dye.…”

“…Three studies have previously investigated the effect of ICG on pathological outcomes. 5,11,12 Mehta et al examined the distance between the tumor and the parenchymal plane of section, first marked by the surgeon and second visualized after injection of the dye. Their results showed a difference of 2.41 cm.…”

Feasibility and Safety of Uniportal Thoracoscopic Segmentectomy Using a Unidirectional Dissection Approach without Dissecting a Fissure

“…In this report, they also recommended that the pulmonary vein be divided last and at the most peripheral site possible to prevent the division of a segmental vein that also drains another segment. Furthermore, in thoracoscopic pulmonary segmentectomy, which we described previously [ 18 ], this preoperative simulation using infrared thoracoscopic observation with ICG administration helped to ensure a sufficient surgical margin. Therefore, in our department, every patient who underwent thoracoscopic segmentectomy had 3DCTBA preoperatively, except for those with contrast allergy.…”

“…Figure 2 shows the correspondence between the preoperatively simulated and actual branching patterns of the pulmonary vessels and bronchi. Ziostation2 software was used to simulate the virtual intersegmental plane preoperatively to ensure a sufficient surgical margin [ 18 , 19 ].…”

“…Figure 2 shows the correspondence between the preoperatively simulated and actual branching patterns of the pulmonary vessels and bronchi. Ziostation2 software was used to simulate the virtual intersegmental plane preoperatively to ensure a sufficient surgical margin [18,19]. Correspondence between preoperatively simulated and actual branching patterns of pulmonary vessels and bronchi during uniportal thoracoscopic right lateral and posterior basal segmentectomy using a unidirectional dissection approach.…”