A simple and effective technique for identification of intersegmental planes by infrared thoracoscopy after transbronchial injection of indocyanine green

Sekine, Yasuo; Ko, Eitetsu; Oishi, Hideto; Miwa, Makoto

doi:10.1016/j.jtcvs.2012.01.079

Cited by 116 publications

(101 citation statements)

References 14 publications

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“…Other methods for recognizing the intersegmental plane are reported, including a method of transbronchial infusion of indocyanine green (ICG) into the pulmonary segment for dissection (30,31) and intravenous injection of ICG after segmental artery cutting to identify the difference of blood flow between the intersegmental plane using an infrared imaging thoracoscopic device (32). ICG infused transbronchially might not spread uniformly in the segmental parenchyma.…”

Section: Discussionmentioning

confidence: 99%

Determination of the intersegmental plane using the slip-knot method

Endoh¹,

Oizumi²,

Kato³

et al. 2018

J. Thorac. Dis.

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Background: Visualization of intersegmental planes in the lung is desirable for precise anatomical lung segmentectomy. We developed the slip-knot method for creating inflation-deflation lines. This study aimed to assess relevant data for thoracoscopic segmentectomy performed using this method. Methods: In the slip-knot method, the objective segmental bronchus is looped with a monofilament thread.One end of the thread is then pulled during temporary bilateral ventilation, causing the knot to slip toward the bronchus. Thereafter, bronchial ligation is tightened to block the outflow of segmental air, ensuring that the segment remains expanded while the other reserved segments collapse on resumption of unilateral ventilation. Data from 221 patients who underwent thoracoscopic pulmonary segmentectomy between 2010 and 2016 were analyzed. Results: A total of 147 patients (67%) were indicated for the slip-knot method, and 74 cases (33%) were non-adaptive cases. Ninety six percent of 147 cases were well adapted to the slip-knot method, which allowed us to obtain good inflation-deflation line images to determine the intersegmental plane. The mean operative time was 171±51 min (range, 71-367 min). The mean duration of chest tube insertion was 1.5±1.2 days (range, 1-7 days). Three cases (2.0%) had prolonged air-leakage and one (0.7%) case had readmission for late air-leakage. Conclusions: Our method enables determination of anatomical intersegmental planes using only one monofilament thread, thus facilitating thoracoscopic pulmonary anatomical segmentectomy.

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Section: Discussionmentioning

confidence: 99%

Determination of the intersegmental plane using the slip-knot method

Endoh¹,

Oizumi²,

Kato³

et al. 2018

J. Thorac. Dis.

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“…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.…”

Section: Commentsmentioning

confidence: 99%

“…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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“…Because of these difficulties, various modifications have been reported. Direct air inflation and the injection of methylene blue or indocyanine green stain into the bronchus using a puncture needle inserted from the operative field were reported to be useful (8)(9)(10)(11). However, great care is essential as this approach can reportedly cause air embolism (12).…”

Section: Technical Aspects Of Vats Subsegmentectomymentioning

confidence: 99%

Video-assisted thoracoscopic subsegmentectomy for small-sized pulmonary nodules

et al. 2017

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Segmentectomy has been widely performed as one of the types of limited resections that are performed for the resection of small-sized lung nodules. Video-assisted thoracoscopic surgery has also been in demand as a minimally invasive surgery. Subsegmentectomy is a much more limited resection than segmentectomy, but the technique is complex because it requires keen anatomical identification of small pulmonary structures. Therefore, there has been little reported about subsegmentectomy in medical literature. The recent development of computed tomography is remarkable, and some reports describe three-dimensional computed tomography as providing useful information because it assists surgeons in the performance of thoracoscopic anatomical subsegmentectomy. The creation of an intersubsegmental line is a key process in subsegmentectomy, therefore, some methods have been reported. We have safely and accurately performed some video-assisted thoracoscopic subsegmentectomies for small-sized lung tumors, using the three-dimensional computed tomography simulation and creating the intersubsegmental line with the inflation-deflation technique. In this article, we describe the recent techniques and roles of video-assisted thoracoscopic subsegmentectomy, and offer prospects for this procedure with our clinical data. more anatomically detailed resection that can involve the dissection of hilar lymph nodes attached to the segment containing the tumor. Moreover, the oncological outcomes of segmentectomy in a propensity-matched study were comparable to those of lobectomy for patients with earlystage non-small cell lung cancer (6). Segmentectomy has thus become widely used worldwide (1). While wedge resection has been applied to smaller lung nodules located in peripheral parenchyma, segmentectomy has been applied to small-sized lung nodules that show not only GGOs, but also solid appearances located in deep parenchyma. Recent developed CT enabled the detection of small-sized pulmonary nodules containing GGO component. For such smaller pulmonary nodules, especially located in the deep parenchyma, subsegmentectomy may be an alternative procedure; this is because it is difficult to perform a wedge resection for hilum nodules located in the deep parenchyma and segmentectomy may be an excessive resection for appropriate surgical margins.The role of subsegmentectomy is therefore considered as an intermediate procedure between wedge resection and segmentectomy. Consequently, we have concluded that the best indications for subsegmentectomy are as follows: (I) lung tumors of indeterminate nature, but considered suspicious for malignancy; (II) planned resection of a cT1aN0M0 primary lung cancer tumor less than 2 cm in diameter, with a GGO ratio of greater than 80% by highresolution CT, in patients with good pulmonary function who are able to tolerate lobectomy ( Figure 1A,B,C); (III) compromised resection in patients who are considered to be poor candidates for lobectomy due to limited cardiopulmonary reserve or other organ failure; (...

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A simple and effective technique for identification of intersegmental planes by infrared thoracoscopy after transbronchial injection of indocyanine green

Abstract: Transbronchial indocyanine green injection into the relevant bronchus with the use of an infrared thoracoscope allows identification of intersegmental lines and planes during thoracoscopic segmentectomy.

Cited by 116 publications

References 14 publications

Determination of the intersegmental plane using the slip-knot method

Determination of the intersegmental plane using the slip-knot method

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

Video-assisted thoracoscopic subsegmentectomy for small-sized pulmonary nodules

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