Is the near‐infrared fluorescence imaging with intravenous indocyanine green method for identifying the intersegmental plane concordant with the modified inflation‐deflation method in lung segmentectomy?

Abstract

Objectives At present, the modified inflation‐deflation method is accepted and widely used in the clinic, but the near‐infrared (NIR) fluorescence imaging with intravenous indocyanine green (ICG) method can also delineate the intersegmental demarcation. However, whether the two methods identify that the intersegmental plane is concordant with each other and match the real intersegmental demarcation is still unknown. Methods Between March 2019 to July 2019, 19 consecutive segmentectomies were performed, using both methods to delineate the intersegmental plane, in order to evaluate and verify whether the intersegmental plane results created by the two methods were concordant and matched the real intersegmental demarcation. Results Segmentectomies were carried out using uniportal video‐assisted thoracic surgery (UVATS) successfully with no intraoperative conversions or ICG‐related complications and only three cases (15.8%) with postoperative complications related to the operation. The intersegmental plane generated by the NIR fluorescence imaging with intravenous ICG method was found to be totally concordant with the modified inflation‐deflation method that was approaching the real intersegmental demarcation in all 19 cases. Conclusions Both methods revealed the intersegmental plane clearly, and the NIR fluorescence imaging with intravenous ICG method was found to be totally concordant with the modified inflation‐deflation method, which is highly concordant with the real intersegmental demarcation. NIR fluorescence imaging with intravenous ICG method may be more popular because of its safety, efficiency, and less complicated restrictions, especially in patients with pulmonary emphysema. Low doses of ICG do not affect the rate of identification of the intersegmental plane and is safer from drug toxicology.

Combination of nitrous oxide and the modified inflation‐deflation method for identifying the intersegmental plane in segmentectomy: A randomized controlled trial

“…Thus, the formation of an available demarcation is closely related to precise reconstruction results and pulmonary parenchyma quality. Moreover, Sun et al have verified that the modified inflation‐deflation method and the NIR fluorescence imaging with intravenous ICG method are totally concordant, which is highly concordant with the real intersegmental demarcation 9 …”

“…In view of these criticisms, a comprehensive understanding of the factors that affect the appearance of the ISP in this procedure is essential to improve this technology. During this process, the speed of the ISP formation is determined by the collapse rate of the preserved segments of nonventilated lung (NVL) after the initiation of one‐lung ventilation (OLV) 9 . Furthermore, two distinct mechanisms are primarily involved in determination of the lung collapse.…”

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

“…Based on a large amount of clinical data, we found that the identification rate of IBL via the ICGF‐based method is comparable to the traditional MID method, which is globally accepted. Furthermore, in our previous study we proved that the IBL created by the ICGF‐based method was highly concordant with the MID method and matched the real segmental fissure 15 . For patients with impaired lung function, such as emphysema or extensive pleural adhesions, the IBL was hard to identify using the MID method because of decreased lung compliance 9 .…”

“…However, precise dissection of target segmental structures based on the reconstructed dynamic 3D images is the prerequisite for presenting an accurate IBL. In our center, the software IQQA system was used to reconstruct 3D images of segmental arteries, veins, and bronchi of candidate patients undergoing segmentectomy for preoperative surgical simulation 15 . In addition, the reconstructed dynamic 3D images could accurately identify the anatomical variation characteristics and the incidence of postoperative complications could be significantly reduced 20 .…”

“…Due to narrowing of the surgical field of view leading to the lack of working space in the context of uniport VATS by the MID method, the ICG fluorescence (ICGF)‐based method has been considered advantageous for delineating the IBL without lung reinflation. In our previous study, we demonstrated that the IBL created by the ICGF‐based method, which is based on the degree of blood flow, was highly concordant with the MID method matching the real segmental fissure 15 . However, to our knowledge, there were no retrospective studies or prospective trials to report the perioperative results of these two methods in uniport VATS segmentectomy.…”