Fluorescence-guided thoracic surgery

Abstract

Recently, the use of sublobar resection has become increasingly common for patients that were previously planned to undergo lobectomy. We encountered two challenges when performing sublobar resections for patients with small pulmonary nodules; one challenge was obtaining a sufficient surgical margin and the other was identifying the location of the nodules, especially in minimally invasive surgery. In recent years, indocyanine green (ICG) fluorescence has been used to solve these two problems in thoracic surgery: first, identifying the accurate intersegmental plane in anatomical lung segmentectomy for detecting the regions of residual pulmonary blood flow, and second, displaying the tumor location or optimal resection line intraoperatively as ICG virtual-assisted lung mapping (ICG-VAL-MAP). The purpose of this article is to present a review of the outcomes of fluorescence-guided thoracic surgery, and also our techniques in minimally invasive surgery using ICG fluorescence. We showed that patients received anatomical pulmonary resection that identified the intersegmental or interlobar plane using ICG guidance in video-assisted thoracic surgery (VATS) or in robot-assisted segmentectomy. We also showed that patients received pulmonary wedge resection, displaying the tumor location intraoperatively using ICG. Furthermore, we introduced a technique of preoperative transbronchial lung marking for small lung nodules called ICG-VAL-MAP.Fluorescence guidance in minimally invasive thoracic surgery makes it possible to ensure a safe surgical margin and identify the intersegmental line and location of the nodules accurately.

Complete visualization using indocyanine green in thoracic surgery for pulmonary sequestration

“…ICG is widely used in surgery for several organs. In thoracic surgery, the use of ICG has been introduced as a technique to detect organ blood flow ( 9 - 11 ). With advances in fluorescence surgery, visualization of the boundary between normal and sequestrated lungs using ICG is now performed for PS surgery ( 3 , 12 - 17 ).…”

Influencing Factors on Intersegmental Identification Adequacy in Segmentectomy with Intraoperative Indocyanine Green (ICG) Intravenous Administration

“…If accurate intersegmental dissection is not performed, there is a risk of the tumor not being included in the lung to be excised, insufficient tumor margins, inadvertent cutting into the tumor, or ischemia of the residual lung due to the incorrect site of resection. Therefore, identifying the intersegmental plane is a crucial procedure in segmentectomy [4][5][6][7][8][9][10][11][12]. Traditionally, the process of identifying intersegmental boundaries involved blocking the bronchi within the resection area and determining the inflation-deflation line.…”