Uniportal video-assisted thoracic lung segmentectomy with near infrared/indocyanine green intersegmental plane identification

Meacci, Elisa; Nachira, Dania; Congedo, Maria Teresa; Chiappetta, Marco; Ciavarella, Leonardo Petracca; Margaritora, Stefano

doi:10.21037/jovs.2017.12.16

Cited by 16 publications

(17 citation statements)

References 18 publications

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“…Preoperative CT-based planning offers similar operative time, mortality, morbidity, and complication rates with the advantage of identifying difficult surgical cases early [55]. Other studies have demonstrated intraoperative identification of intersegmental planes after segmental artery ligation and distal injection of ICG or indigo carmine dyes [59–63]. This approach allows identification of resection planes by naked eye or with NIR fluorescence, potentially enabling safer and effective resection.…”

Section: Discussionmentioning

confidence: 99%

Nanoparticle-based CT visualization of pulmonary vasculature for minimally-invasive thoracic surgery planning

Chan

Ujiie

et al. 2019

PLoS ONE

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PurposeTo evaluate CF800, a novel lipid-based liposomal nanoparticle that co-encapsulates indocyanine green (ICG) and iohexol, for CT imaging of pulmonary vasculature in minimally-invasive thoracic surgery planning.MethodsCF800 was intravenously administered to 7 healthy rabbits. In vivo CT imaging was performed 15 min post-injection, with a subset of animals imaged at 24h, 48h, and 72h post injection. Signal-to-background ratios (SBR) were calculated at the inferior vena cava and compared across time-points. A similar protocol was applied to 2 healthy pigs to evaluate the feasibility and efficacy in a large animal model. To evaluate the feasibility of clinical application, a survey was completed by 7 surgical trainees to assess pre- and post-injection CT images of rabbits and pigs. Responses on the discernibility of pulmonary vasculature sub-branches and comfort level to use the images for pre-operative planning were collected and analyzed.ResultsCF800 injection improved visualization of pulmonary vessels in both rabbit and pig models. The SBR of rabbit pulmonary vasculature was significantly higher after CF800 injection (range 3.7–4.4) compared to pre-injection (range 3.3–3.8, n = 7; p<0.05). SBR remained significantly different up to 24 hours after injection (range 3.7–4.3, n = 4; p<0.05). Trainees’ evaluation found the post-injection CT images had significantly higher discernibility at the second vessel branch generation in both rabbit and pig models. Trainees identified smaller vasculature branch generations in the post-injection images compared to the pre-treatment images in both rabbit (mean 6.7±1.8 vs 5.4±2.1; p<0.05) and pig (mean 6.7±1.8 vs 5.4±2.1; p<0.05). Trainees were significantly more comfortable using post-injection images for surgical planning compared to the pre-injection images (rabbit: 8.1±1.1 vs. 4.7±2.1; pig: 7.6±2.1 vs. 4.9±2.2; p<0.05).ConclusionCF800 provides SBR and contrast enhancement of pulmonary vasculature which may assist in pre-surgical CT planning of minimally invasive thoracic surgery.

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Section: Discussionmentioning

confidence: 99%

Nanoparticle-based CT visualization of pulmonary vasculature for minimally-invasive thoracic surgery planning

Chan

Ujiie

et al. 2019

PLoS ONE

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“…According to toxicity studies, a 5.0 mg/kg ICG intravenous injection is safe and tolerable. 17 In order to reduce the dose of ICG and improve the safety, we used 0.5 mg/ kg ICG injection and the blue intensity was clear. Maximum blue intensity is gained in about 1 minute, then lasts for 10 minutes.…”

Section: Discussionmentioning

confidence: 99%

“…Recent evidences showed that VATS-based segmentectomy has rendered better postoperative pulmonary function and faster postoperative recovery than VATS-based lobectomy. 17 The difficulty of segmentectomy lies in the confirmation of the intersegmental plane. 11 It is important to perform adequate preoperative evaluation such as using 3-dimensional reconstruction of CT images in order to identify the dominant artery and bronchi to the target segment in preoperative planning.…”

Section: Discussionmentioning

confidence: 99%

Clinical Application of Near-Infrared Thoracoscopy With Indocyanine Green in Video-Assisted Thoracoscopic Anatomical Segmentectomy

et al. 2019

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Background. To confirm the impact of near-infrared thoracoscopy with intravenous injection of indocyanine green (ICG) during video-assisted thoracic surgery (VATS)-based segmentectomy. Materials and Methods. We retrospectively screened the perioperative data in total 21 patients who underwent segmentectomy by VATS. The segmental arteries and bronchi were identified with the help of preoperative 3-dimensional computed tomography images. Among them, clinical effectiveness and postoperative complications were analyzed. VATS segmentectomy was performed using a 3-port approach with systemic intravenous injection of ICG. Results. A total of 21 patients underwent VATS-based segmentectomy with ICG injection. The mean operation time was 126.19 ± 15.32 minutes, and the mean bleeding volume was 158.10 ± 39.95 mL. In addition, the average drainage volume 1 day after surgery was 153.81 ± 32.19 mL, and mean duration of drainage was 1.62 ± 0.59 days. Complications occurred in 6 of the 21 patients. Two patients had pneumonia, 3 had arrhythmia, and 1 had prolonged air leak. There were no complications resulting from ICG angiography. Conclusions. Near-infrared thoracoscopy with intravenous injection of ICG is a safe, fast, simple, and highly accurate method that can be used to identify the intersegmental plane and facilitate the quality of VATS-based segmentectomy.

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“…10 This technology has been applied to the demarcation of intersegmental planes for pulmonary segmentectomy and has been reported to be safe and feasible, attracting increasing attention from a multitude of thoracic surgeons. 5,6,[11][12][13][14][15][16][17][18][19] This is a prospective phase I/II clinical study conducted to evaluate NIR image-guided pulmonary segmentectomy after endobronchial ICG injection according to the predetermined assessment items described in Figure 2. NIR fluorescence-guided pulmonary segmentectomy was initially accompanied by the intravenous injection of ICG and NIR thoracoscopy in Japan.…”

Section: Commentmentioning

confidence: 99%

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

Wada

Yamamoto

Morimoto

et al. 2020

The Annals of Thoracic Surgery

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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.

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Uniportal video-assisted thoracic lung segmentectomy with near infrared/indocyanine green intersegmental plane identification

Cited by 16 publications

References 18 publications

Nanoparticle-based CT visualization of pulmonary vasculature for minimally-invasive thoracic surgery planning

Nanoparticle-based CT visualization of pulmonary vasculature for minimally-invasive thoracic surgery planning

Clinical Application of Near-Infrared Thoracoscopy With Indocyanine Green in Video-Assisted Thoracoscopic Anatomical Segmentectomy

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

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