Usefulness of near-infrared angiography for identifying the intersegmental plane and vascular supply during video-assisted thoracoscopic segmentectomy†

Guigard, Sébastien; Triponez, Frédéric; Bédat, Benoît; Vidal-Fortuny, Jordi; Licker, Marc; Karenovicŝ, Wolfram

doi:10.1093/icvts/ivx225

Cited by 40 publications

(46 citation statements)

References 21 publications

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“…Impact of near-infrared angiography on the quality of anatomical resection during video-assisted thoracic surgery segmentectomy infrared angiography leads to a better understanding of the vascular anatomy, this could also facilitate the surgical approach during VATS and improve the success and quality of the segmentectomy (7).…”

Section: Original Articlementioning

confidence: 99%

“…Intercostal blockade using local anesthesia was routinely performed at the beginning of the thoracoscopy. The ISP was identified as previously described by Guigard et al technique (7). After intravenous injection of ICG solution (12.5 mg), visualization of nearinfrared light emitted by the excited ICG facilitated the distinction between vascularized and non-vascularized tissues.…”

Section: Surgical Approach and Icg Angiographymentioning

confidence: 99%

“…Nevertheless, the surgeon needs intraoperative assistance to identify the ISP. As previously described, near-infrared angiography with indocyanine green (ICG) can be helpful in the identification of the ISP during VATS (7)(8)(9). In contrast to bronchial segmentation, vascular segmentation with ICG is easier and can enable precise anatomical resection.…”

Section: Introductionmentioning

confidence: 99%

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Impact of near-infrared angiography on the quality of anatomical resection during video-assisted thoracic surgery segmentectomy

et al. 2018

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Background:The aim of the present study was to assess the impact of near-infrared angiography in guiding intraoperatively sublobar anatomical resection by video-assisted thoracic surgery (VATS). Methods: We retrospectively analyzed data from 67 patients who underwent segmentectomy by VATS from November 2014 to November 2017 at the University Hospitals of Geneva, Switzerland. The need to modify arterial or parenchymal resection based on intraoperative near-infrared imaging was considered the primary study outcome. Results: A total of 67 patients (28 men, 39 women, mean age 66±10 years) underwent anatomical pulmonary segmentectomy by VATS. Histological analysis revealed a primary lung tumor in 59 patients. The mean ± standard deviation (SD) operation time was 154±51 minutes. Identification of the intersegmental plane (ISP) with near-infrared angiography was achieved in 88% of patients and led to modification of the resection during segmentectomy in 7 patients (10%), avoiding inappropriate resection; 2 patients had distant tumor recurrences (3%). Conclusions: Near-infrared angiography during VATS segmentectomy is effective for identifying ISPs, with respect to the oncological margins, as well as for correcting the anatomical resection.

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Section: Original Articlementioning

confidence: 99%

Section: Surgical Approach and Icg Angiographymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of near-infrared angiography on the quality of anatomical resection during video-assisted thoracic surgery segmentectomy

et al. 2018

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“…The operation time was signi cantly shortened. Besides, the brightness of ICG uorescence mainly depends on both the ICG concentration in blood vessels and the blood ow in the pulmonary artery (15), it is also in uenced by the condition of the pulmonary parenchyma, including anthoracosis and emphysema (16). It may be di cult to clearly visualize the entire intersegmental plane using ICG in patients with severe emphysema, as the blood ow in emphysematous regions is quite low.…”

Section: Discussionmentioning

confidence: 99%

Near-Infrared intraoperative imaging with indocyanine green is feasible in segmentectomy for patients with chronic lung diseases: A retrospective single-center propensity-score matched analysis

Liu¹,

Yang²,

Cao³

2020

Preprint

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Abstract Objective To investigate whether video-assisted thoracoscopic segmentectomy using near-infrared fluorescence imaging had better intersegmental plane visualization and peri-operative outcome in patients with chronic lung diseases. Methods Data were collected retrospectively from March 2014 and August 2019. A total of 92 patients with pulmonary nodules underwent near-infrared fluorescence guided uni-port thoracoscopic segmentectomy(NIF-VATS), 149 patients underwent thoracoscopic segmentectomy with inflation-deflation method(ID-VATS). After 1:1 propensity matching, perioperative outcomes between NIF-VATS and ID-VATS was compared. Results Incision size was 3 cm in both group.Mean operative time was 79 minutes in NIF-VATS group and 96 minutes in ID-VATS group. The intersegmental plane was not clear in 33 cases of ID-VATS group, and no clear boundary was found after prolonged waiting time. Emphysema or pulmonary bullae could be found in chest CT scan in these patients, they all were diagnosed as chronic obstructive pulmonary disease. In NIF-VATS group, the intersegmental plane was not clear in 8 cases. Under the guidance of three-dimensional reconstruction and preoperative positioning, the oncological margin length of both groups met the requirements of surgical quality control. The intraoperative blood loss, number of lymph node resection, showed no statistical difference between the two groups. Postoperative air leakage was more often observed in ID-VATS group. The postoperative drainage duration, postoperative hospitalization time was shorter in ID-VATS group. Conclusions Compared with inflation-deflation method, segmentectomy using NIF imaging is feasible for patients with chronic lung diseases with better intersegmental plane, shorter operation time, less complications, it might lead to faster recovery.

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“…This will require greater accuracy, which can only be achieved with the help of some technologies. Examples include 3-dimensional modelisation for a better understanding of anatomy (11,12), mapping to locate a micronodule and delineate margins (13), intersegmental plane marking by techniques such as infrared imaging combined with systemic injection of indocyanine green (14). In an near future, virtual navigation inside the lung-as shown at the start-up corner during the conference, and augmented reality will enter our operating rooms and facilitate sublobar resections.…”

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confidence: 99%

A conference at the onset of a new era

Gossot

2018

J. Thorac. Dis.

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Lung cancer surgery is evolving rapidly, faster than we could imagined a few years ago. This rapid development is related to the following observations: (I) in many countries, the tumor profile has changed dramatically, with an increasing rate of ground glass opacities and cancers detected at an early stage. This evolution is partly due to the screening programs and to the strong demand from patients and their doctors to have a CT-scan; (II) when a small suspicious pulmonary nodule is discovered, the patient legitimately asks about the most effective treatment but also the less invasive one. Surgery is now competing with other treatments, in particular stereotactic radiotherapy (SBRT) or radiofrequency whose mortality is close to zero with a morbidity comprised between 1% and 2% (1). Thus, although SBRT may have a slightly higher local recurrence rate than surgical resection and lower survival, this very low morbidity may make it the technique of choice in elderly and/ or fragile patients (2). In the near future, some small tumors may also be destroyed endoscopically using Electromagnetic Navigation Bronchoscopy. Engineers are actively working on it. Driven by these developments, the dogma of "lobectomy as standard treatment" for all non-small cell lung cancers (NSCLC), regardless of patient's age and profile, is faltering. As written by Cao, some surgeons now ask themselves the question "Could less be more?" (3). Indeed, although results of randomized trials are still pending (4,5), several recent studies seem to indicate that oncology results and survival of LRTs are equivalent to those of lobectomies for early stage NSCLC (6-8), while morbidity is much lower (9), especially when the procedure is performed via a closed chest approach (10). Finally, in 2018, more and more surgeons are choosing to treat a small tumor with a sublobar resection and the majority agree that the maximum benefit of the procedure is obtained when done by thoracoscopy. The current concern is that thoracoscopic

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Usefulness of near-infrared angiography for identifying the intersegmental plane and vascular supply during video-assisted thoracoscopic segmentectomy†

Abstract: Indocyanine green angiography provides technical support for identifying the intersegmental plane and the vasculature during VATS segmentectomy. It contributes to the quality of diagnostic and therapeutic excisions of small nodules that are often not visible and not palpable during VATS.

Cited by 40 publications

References 21 publications

Impact of near-infrared angiography on the quality of anatomical resection during video-assisted thoracic surgery segmentectomy

Impact of near-infrared angiography on the quality of anatomical resection during video-assisted thoracic surgery segmentectomy

Near-Infrared intraoperative imaging with indocyanine green is feasible in segmentectomy for patients with chronic lung diseases: A retrospective single-center propensity-score matched analysis

A conference at the onset of a new era

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