Clarification of the resection line non-intubated segmentectomy using indocyanine green

Čan, Vladimír; Kala, Zdeněk; Frola, Lukáš; Hudacek, Kamil; Kališ, Vladimír; Kodýtková, Alžběta; Mitáš, Ladislav; Moravčík, Petr; Rybníčková, Sylva; Skřivanová, Kateřina; Marketa, Spankova; Vach, Robert; Horváth, Theodor

doi:10.21037/atm.2019.01.45

Cited by 3 publications

(5 citation statements)

References 31 publications

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“…Three hundred sixty-three cases of lobectomy or anatomical segmentectomy within a 3-year period were included. They excluded 24 intubated anatomical segmentectomies.…”

Section: Methodsmentioning

confidence: 99%

“…Some attempts from Europe have also been published (18,20,24), but have not gained continuity and have not spread thus reflecting the complexity.…”

Section: Methodsmentioning

confidence: 99%

“…We present the following article in accordance with the Narrative Review reporting checklist (available at https:// dx.doi.org/10.21037/jovs- [21][22][23][24][25][26][27][28][29][30][31][32][33].…”

Section: Introductionmentioning

confidence: 99%

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Nonintubated anatomical segmentectomy: does the benefit overcome the risks?—a narrative review

Gálvez¹,

Bolufer²,

Corcoles³

et al. 2022

J Vis Surg

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Objective: Search the evidence available regarding nonintubated anatomical segmentectomies and discuss about outcomes.Background: Nonintubated thoracic surgery has evolved since initial "rescue procedures" for highrisk patients under awake anesthesia, until sedative nonintubated resections including anatomical segmentectomies. Nonetheless, very few experienced centers in Asia have collected most of this short caseload worldwide, thus reflecting the difficult advance in this very specific minimally-invasive procedure. In fact, the evidence about nonintubated segmentectomies suggests only little benefits in terms of postoperative recovery (chest tube duration, hospital stay). Methods:We review comparative studies, randomized trials, systematic reviews and meta-analysis about nonintubated segmentectomies since its first report. We focused in some controversial aspects and which the conclusions should be.Conclusions: Evidence regarding the potential benefit of nonintubated segmentectomies is really poor nowadays due to very few studies reported from just highly-experienced centers. The evidence points to a better postoperative recovery in terms of chest tube duration and hospital stay, but these advantages are limited by non-randomized design and methodological biases. Nonetheless the standard with general anesthesia and orotracheal intubation is highly safe in the low-risk cohort of patients strictly selected for nonintubated segmentectomies, so it seems that the expected advantages of this anesthetic method have not been reached or at least not been assessed, especially those regarding respiratory complications and stress biomarkers. Efforts should be made in order to clarify the concepts and the targeted population, homogenize the anesthetic methods, design randomized trials assessing the variables where the expected benefits can be measured, and state conclusion according to these outcomes.

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“…Three hundred sixty-three cases of lobectomy or anatomical segmentectomy within a 3-year period were included. They excluded 24 intubated anatomical segmentectomies.…”

Section: Methodsmentioning

confidence: 99%

“…Some attempts from Europe have also been published (18,20,24), but have not gained continuity and have not spread thus reflecting the complexity.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Nonintubated anatomical segmentectomy: does the benefit overcome the risks?—a narrative review

Gálvez¹,

Bolufer²,

Corcoles³

et al. 2022

J Vis Surg

View full text Add to dashboard Cite

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“…Considering segmentectomy, the identification of the intersegmental planes can be challenging without mechanical ventilation and some alternative techniques have been proposed to identify the cutting intersegmental line: the most common intraoperative techniques are represented by endovascular injection of indocyanine-green (ICG), visible using near-infrared thoracoscopy, and intrabronchial marking with ICG injection under bronchoscopy or electromagnetic navigation bronchoscopy (16,17). In the first case, once the pulmonary artery is clamped or resected, intravenous-injected ICG distributes to the target segment and helps to identify the intersegmental planes.…”

Section: Planning Surgerymentioning

confidence: 99%

“…In the first case, once the pulmonary artery is clamped or resected, intravenous-injected ICG distributes to the target segment and helps to identify the intersegmental planes. The dividing line is evidenced by a fluorescent boundary between perfused (bright area) and devascularized segments (dark area) (16). In the second case, ICG is instilled in the segmental bronchus, has a longer duration in the alveoli if compared with intravenous ICG administration and no repeated injection is required selective bronchial inflation using a fine needle described by Kamiyoshihara is no longer used due to the risk of air embolism and subsequent severe complications (18).…”

Section: Planning Surgerymentioning

confidence: 99%

Major lung resections with spontaneous ventilation: a narrative review

Diotti¹,

Tosi²

2022

AME Surg J

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In the last decades, technical improvements and the advance of innovative technologies have made thoracic surgery increasingly less invasive: video-assisted thoracic surgery (VATS) is now considered the best approach for early-stage non-small cell lung cancer (NSCLC) surgical treatment, and has become the first choice for many non-oncological thoracic diseases requiring surgery, with proved advantages in terms of less post-operative pain, fewer complications and a faster recovery. Combining minimally invasive surgical and anaesthetic techniques is one of the new frontiers of thoracic surgery: in this scenario nonintubated thoracic surgery (NITS) is a promising approach to minimize risks related to general anaesthesia and intubation, promote a faster recovery and reduce hospital stay. Since its first reported applications for minor thoracic procedures in the late 90s, NITS has emerged as a promising technique and it is recently being applied also to technical demanding major thoracic anatomical resections, such as lobectomies and segmentectomies, with encouraging results concerning feasibility, perioperative outcomes and complication rates. The oncological value of NITS is also being explored: recent studies show better compliance with adjuvant chemotherapy protocols and fewer events of toxicity in patients treated with NITS procedures. The aim of this narrative review is to investigate the role of NITS applied to major lung resections in terms of feasibility, short-term outcomes and applications in everyday clinical practice.

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A risk score for predicting postoperative complications in non-intubated thoracic surgery

Lan¹,

Jiang²,

Duan³

et al. 2021

J Thorac Dis

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Background: The risk factors for postoperative complications in non-intubated video-assisted thoracoscopic surgery (VATS) have not been observed before. Here to develop a simple risk score to predict the risk of postoperative complications for patients who scheduling non-intubated VATS, which is beneficial to guide the clinical interventions. Methods: A total of 1,837 patients who underwent non-intubated VATS were included from January 2011 to December 2018. A development data set and a validation data set were allocated according to an approximate 3:2 ratio of total cases. The stepwise logistic regression was used to establish a risk score model, and the methods of bootstrap and split-sample were used for validation.Results: Multivariable analysis revealed that the forced expiratory volume in the first second in percent of predicted, the anesthesia method, blood loss, surgical time, and preoperative neutrophil ratio were risk factors for postoperative complications. The risk score was established with these 5 factors, varied from 0 to 53, with the corresponding predicted probability of postoperative complications occurrence ranged from 1% to 92% and was calibrated (Hosmer-Lemeshow χ 2 =6.261; P=0.618). Good discrimination was acquired in the development and validation data sets (C-statistic 0.705 and 0.700). A positive correlation was between the risk score and postoperative complications (P for trend <0.01). Three levels of low-risk (0-15 points], moderate-risk (15-30 points], and high-risk (>30 points] were established based on the score distribution of postoperative complications. Conclusions: This simple risk score model based on risk factors of postoperative complications can validly identify the high-risk patients with postoperative complications in the non-intubated VATS, and allow for early interventions.

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Clarification of the resection line non-intubated segmentectomy using indocyanine green

Abstract: A reflection on the measure of fluorescence specificity of indocyanine green (ICG) in nonintubated pulmonary segmentectomy.

Cited by 3 publications

References 31 publications

Nonintubated anatomical segmentectomy: does the benefit overcome the risks?—a narrative review

Nonintubated anatomical segmentectomy: does the benefit overcome the risks?—a narrative review

Major lung resections with spontaneous ventilation: a narrative review

A risk score for predicting postoperative complications in non-intubated thoracic surgery

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