A New Method to Identify Air Leaks After Pulmonary Resection Using Indocyanine Green Aerosol

Yokota, Naoya; Go, Tetsuhiko; Otsuki, Yoshinori; Soo, Chan Sang; Misaki, Hironori; Yokomise, Hiroyasu

doi:10.1016/j.athoracsur.2022.03.058

Cited by 8 publications

(7 citation statements)

References 14 publications

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“…This pressure is commonly applied by respiratory surgeons to perform leak tests after pneumonectomy. 11 In patients with simultaneous pleural fluids and ascites effusions, there are three differential conditions: porous diaphragm, clinical pleuroperitoneal communication, and Meigs syndrome (or pseudo-Meigs syndrome). Porous diaphragm is diagnosed when a diaphragmatic defect is identified during thoracoscopic surgery or thoracotomy.…”

Section: Discussionmentioning

confidence: 99%

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Cases of pleural effusion possibly due to clinical pleuroperitoneal communication in the perioperative period of emergency gynecologic surgery: Case series and literature review

Tanaka,

Amano,

Nakata

et al. 2024

J of Obstet and Gynaecol

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Pleuroperitoneal communication poses a respiratory failure risk due to pleural fluid accumulation with thoracic migration of ascites. Here, we discuss the following cases: Case 1: A woman was diagnosed with a ruptured ovarian tumor with right pleural fluid and ascites, without respiratory failure. Ovarian cystectomy was performed with inadequate removal of ascites. Postoperatively, respiratory failure occurred, and thoracentesis detected pleural fluid resembling ascites. Case 2: A woman was diagnosed with a ruptured ectopic pregnancy with right pleural fluid and ascites without respiratory failure. A diagnosis of clinical pleuroperitoneal communication was considered based on computed tomography findings. During laparoscopic salpingectomy, high‐pressure ventilation was performed to push the pleural fluid back into the abdominal cavity; a negative‐pressure drain was inserted, and the ascites was completely removed. Postoperative radiography revealed the absence of pleural fluid. Therefore, a preoperative diagnosis of clinical pleuroperitoneal communication and appropriate intraoperative techniques can prevent postoperative respiratory failure.

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Section: Discussionmentioning

confidence: 99%

“…In our patient, positive pressure ventilation of 20 cm H 2 O was applied to the thoracic cavity to push the pleural fluid back into the abdominal cavity. This pressure is commonly applied by respiratory surgeons to perform leak tests after pneumonectomy 11 …”

Section: Discussionmentioning

confidence: 99%

Cases of pleural effusion possibly due to clinical pleuroperitoneal communication in the perioperative period of emergency gynecologic surgery: Case series and literature review

Tanaka,

Amano,

Nakata

et al. 2024

J of Obstet and Gynaecol

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“…17 In contrast, recent studies have demonstrated that during pulmonary surgery, leak points can be assessed using aerosolized ICG. 13,14 Yokota et al 14 also showed that this technique can identify air leak points overlooked by the traditional methods used in clinical practice. However, we found no previous studies of the fluorescent leak test using aerosolized ICG for the intraoperative assessment of colorectal anastomotic integrity.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Moreover, recent studies showed that aerosolized ICG administration into the airway could identify air leaks arising from pleural defects. 13,14 Aerosolized ICG is administered using a nebulizer kit and is carried by the generated airflow. 13 Therefore, we hypothesized that air leak points within anastomoses could be visualized by administering aerosolized ICG into the rectum transanally; if successful, this could constitute a novel method of intraoperative leak testing.…”

mentioning

confidence: 99%

A Novel Fluorescence-Based Leak Test Method for Rectal Anastomoses Using Aerosolized Indocyanine Green

Kondo,

Yokota,

Kobayashi

et al. 2023

Diseases of the Colon &Amp; Rectum

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BACKGROUND: The intraoperative air leak test is commonly performed during rectal surgery to evaluate anastomotic integrity. However, its drawbacks include occasional difficulties in visualizing the exact point of the leak while maintaining the pelvis under saline, the need for repeat testing to identify the leak point, and a lack of continuous visualization of the leak point. OBJECTIVE: We aimed to evaluate the feasibility and clinical applicability of using aerosolized indocyanine green, a fluorescent tracer, for detecting rectal anastomotic leakage. DESIGN: Animal pre-clinical study. SETTING: Animal laboratory at Kagawa University. PATIENTS: Six healthy adult female beagles were included. INTERVENTIONS: An anastomotic leakage model with a single air leak point was created in each dog. Indocyanine green was aerosolized using a nebulizer kit with a stream of carbon dioxide flowing at 1.5–2.0 L/min. The aerosol was administered into the rectum transanally, and laparoscopic observations were performed. MAIN OUTCOME MEASURES: Air leak points were observed using a near-infrared fluorescence laparoscope, following which the presence of corresponding indocyanine green fluorescence was verified. RESULTS: Aerosolized indocyanine green was visualized laparoscopically at all anastomosis sites but not elsewhere. The median time from the administration of the aerosol to its visualization was 4.5 s. Pathological examinations were performed 4 weeks post-surgery in all dogs, and no histological abnormalities related to aerosolized indocyanine green administration were observed at the anastomosis sites. LIMITATIONS: The leak points were surgically created and did not occur naturally. CONCLUSIONS: Visualization of air leaks at the sites of rectal anastomosis was laparoscopically achievable by administering aerosolized indocyanine green transanally into the rectum in our canine model. This novel fluorescent leak test could be a valid alternative to established methods.

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“…Many surgeons suggest detecting IAALs through an immersion test after completing a VATS anatomical resection (12) or through new methods (13). The next step represents the crux of the prevention of PAL.…”

mentioning

confidence: 99%

Prolonged air leak after lung surgery: prediction, prevention and management

Zaraca¹,

Crisci²,

Augustin³

et al. 2023

J Thorac Dis

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A New Method to Identify Air Leaks After Pulmonary Resection Using Indocyanine Green Aerosol

Cited by 8 publications

References 14 publications

Cases of pleural effusion possibly due to clinical pleuroperitoneal communication in the perioperative period of emergency gynecologic surgery: Case series and literature review

Cases of pleural effusion possibly due to clinical pleuroperitoneal communication in the perioperative period of emergency gynecologic surgery: Case series and literature review

A Novel Fluorescence-Based Leak Test Method for Rectal Anastomoses Using Aerosolized Indocyanine Green

Prolonged air leak after lung surgery: prediction, prevention and management

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