Feasibility investigation of near‐infrared fluorescence imaging with intravenous indocyanine green method in uniport video‐assisted thoracoscopic anatomical segmentectomy for identifying the intersegmental boundary line

Abstract

Objectives To investigate the perioperative outcomes of patients who underwent uniport video‐assisted thoracoscopic (VATS) segmentectomy for identifying the intersegmental boundary line (IBL) by the near‐infrared fluorescence imaging with the intravenous indocyanine green (ICG) method or the modified inflation‐deflation (MID) method and assess the feasibility and effectiveness of the ICG fluorescence (ICGF)‐based method. Methods We retrospectively analyzed the perioperative data in total 198 consecutive patients who underwent uniport VATS segmentectomy between February 2018 and August 2020. With the guidance of a preoperative imaging interpretation and analysis system (IQQA‐3D), the targeted segment structures could be precisely identified and dissected, and then the IBL was confirmed by the ICGF‐based method or the MID method. The clinical effectiveness and postoperative complications of the two methods were evaluated. Results An IBL was visible in 98% of patients in the ICGF‐based group, even with low doses of ICG. The ICGF‐based group was significantly associated with a shorter IBL clear presentation time (23.6 ± 4.4 vs. 23.6 ± 4.4 s) (p < 0.01) and operative time (89.3 ± 31.6 vs. 112.9 ± 33.3 min) (p < 0.01) compared to the MID group. The incidence of postoperative prolonged air leaks was higher in the MID group than in the ICGF‐based group (8/100, 8% vs. 26/98, 26.5%, p = 0.025). There were no significant differences in bleeding volume, chest tube duration, postoperative hospital stays, surgical margin width, and other postoperative complications. Conclusion The ICGF‐based method could highly accurately identify the IBL and make anatomical segmentectomy easier and faster, and therefore has the potential to be a feasible and effective technique to facilitate the quality of uniport VATS segmentectomy.

The Wide Range of Uses of Indocyanine Green in Thoracic Surgery: State of Art

“…Peripheral intravenous injection was widely used and allowed a fast identification of the segmental plane, though central injection showed a faster migration and detention time [26]. Intravenous injection was performed after ligation of segmental structures: only segmental artery ligation [23,24,30,32,34], segmental artery and vein [34] or segmental artery, vein and bronchus [25][26][27]31,33,35]. Transbronchial administration needs a longer time for demarcating the intersegmental plane [29], however with this method ICG stays in the alveolar space up to several hours [63], compared to duration of intersegmental plane demarcation with IV injection of 3.5 min [64].…”

“…In Table 3 is showed a review of the use of ICG for the intersegmental plane identification. The ICG was injected, most commonly, in peripheric vein during the surgery after segment pulmonary artery ligation [23,24,30,32,34] or after segmental pulmonary artery, vein and bronchus [25][26][27]31,33,35]; in Matsuura et al the injection followed the segmental pulmonary artery and bronchus ligation [28]. The minimum time for migration and detention was seconds [23,26,30], the maximum was few minutes [25,32].…”

The Wide Range of Uses of Indocyanine Green in Thoracic Surgery: State-of-the-art

“…The tumor size ranged from a minimum of 0.6 cm [34,35] to a maximum of 6.4 cm [34]. The ICG was administered, most commonly, in peripheric vein during the surgery after segment pulmonary artery ligation [23 -27] or after segmental pulmonary artery, vein and bronchus [28][29][30][31][32][33]. In Matsuura et al the injection followed the segmental pulmonary artery and bronchus ligation [34].…”

“…Peripheral intravenous injection was widely used and allowed a fast identi cation of the segmental plane, though central injection showed a faster migration and detection time [29]. Intravenous injection was performed after ligation of segmental structures: only segmental artery ligation [23][24][25][26][27], segmental artery and vein [27] or segmental artery, vein and bronchus [28][29][30][31][32][33]. Transbronchial administration needs a longer time for demarcating the intersegmental plane [36], however with this method ICG stays in the alveolar space up to several hours [60], compared to duration of intersegmental plane demarcation with IV injection of 3.5 min [61].…”

Robot-assisted segmentectomy with improved inflation-deflation combined with the intravenous indocyanine green method

“…According to published evidence, there are six main methods for accurately identifying ISP, including the in ation-de ation technique, systemic injection of indocyanine green, selective resected segmental in ation, injection of endobronchial dye, 3-dimensional simulation using multidetector computed tomography and virtual-assisted lung mapping 17 . The modi ed in ation-de ation technique and systemic injection of indocyanine green technique are two main methods for creating an ISP [18][19][20][21][22][23] . The advantages and disadvantages of these methods have been well documented.…”