Precise Anatomical Sublobar Resection Using a 3D Medical Image Analyzer and Fluorescence-Guided Surgery With Transbronchial Instillation of Indocyanine Green

Sekine, Yasuo; T, Itoh; Toyoda, Takahide; Kaiho, Tatsuo; Koh, Eitetsu; Kamata, Toshihide; Hoshino, Hidehisa; Hata, Atsushi

doi:10.1053/j.semtcvs.2019.01.004

Cited by 29 publications

(27 citation statements)

References 10 publications

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“…Owing to structural variation, identification of the intersegmental plane (ISP) still present difficulties for thoracic surgeons. To date, several methods for identifying the ISP have been reported, most of which belong to two categories which aim to develop inflation/deflation lines or inject indocyanine green either intravenously or intrabronchially 3‐6 . However, it has been reported that these methods have multiple limitations, 7 and developing a new simple and practical approach to accurately determine the ISP is therefore urgently required.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Background During thoracoscopic segmentectomy, accurately and rapidly identifying the intersegmental plane (ISP) is of great importance. This study aimed to investigate the effect and safety of a nitrous oxide (N2O)/oxygen (O2) inspired mixture on the appearance time of the ISP (TISP) via the modified inflation‐deflation method. Methods A total of 65 participants who underwent segmentectomy were randomized into three groups: 75% N2O (n = 24), 50% N2O (n = 23) or 0% N2O (n = 18). The 75% N2O group received a gas mixture of N2O/O2 (Fio2 = 0.25), the 50% N2O group received N2O/O2 (Fio2 = 0.5), and the 0% N2O group received 100% oxygen during lung expansion. The appearance time of satisfactory and ideal planes was recorded. Furthermore, arterial blood gas at breathing room air, one‐lung ventilation (OLV) before lung expansion, 5 and 15 min after lung expansion were also recorded. Results TISP was significantly shorter in the 75% N2O group (320.2 ± 65.9 s) compared with that of the 50% N2O group (552.4 ± 88.9 s, p < 0.001) and the 0% N2O group (968.3 ± 85.5 s, p < 0.001), while the 50% N2O group was shorter than that of the 0% N2O group (p < 0.001). Arterial oxygenation was significantly improved in the 0% N2O group only after lung expansion, before which there were no differences in mean PaO2 values among groups. Conclusions The use of N2O in the inspired gas mixture during lung expansion is an applicable strategy to rapidly identify the ISP via the modified inflation‐deflation method without any adverse effect on OLV related arterial oxygenation during segmentectomy.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…By ligating the segmental pulmonary artery feeding the target pulmonary segment to be excised in advance, the target pulmonary segment is visualized as a fluorescencedeficient area, while other segments positively exhibit fluorescence. 17 Although this method is simple, the visualization time of the intersegmental plane by ICG fluorescence is as short as several minutes, which is considered a disadvantage. The advantage of using the ICG endobronchial insufflation method for visualizing the targeted segmental bronchus is that once ICG insufflation is performed at induction of general anesthesia, ICG-FL of the targeted segment is longlasting and can be observed continuously during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…If some of the insufflated ICG leaks backward, the net insufflated ICG volume might be less than the estimated volume, which may result in non-uniform insufflation of ICG. By sealing the bronchial lumen with a balloon catheter, such as a Fogarty arterial embolectomy catheter, 17 it is possible to insufflate ICG into the targeted bronchus without ectopic distribution of ICG. Other limitations in this study are the small sample size and the single-center design, which was highly dependent on the operator's bronchoscopic technique.…”

Section: Discussionmentioning

confidence: 99%

Fluorescence visualization of the intersegmental plane by bronchoscopic instillation of indocyanine green into the targeted segmental bronchus: determination of the optimal settings

et al. 2021

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Objective To determine the appropriate amount of indocyanine green for bronchial insufflation. Methods We enrolled 20 consecutive patients scheduled for anatomical segmentectomy in the Kochi Medical School Hospital. After inducing general anesthesia, 6 to 60 mL of 200-fold-diluted indocyanine green (0.0125 mg/mL) was insufflated into the subsegmental bronchi in the targeted pulmonary segmental bronchus. The volume of the targeted pulmonary segments was calculated using preoperative computed tomography. Fluorescence spread in the segmental alveoli was visualized using a dedicated near-infrared thoracoscope. Results The targeted segment was uniformly visualized by indocyanine green fluorescence in 16/20 (80.0%) cases after insufflating indocyanine green. A receiver operating characteristic curve indicated that the area under the curve was 0.984; the optimal cut-off volume of diluted indocyanine green for insufflation was 8.91% of the calculated targeted pulmonary segment volume. Conclusions The setting for indocyanine green insufflation was optimized for near-infrared fluorescence image-guided anatomical segmentectomy. By injecting the correct amount of indocyanine green, fluorescence-guided anatomical segmentation may be performed more appropriately.

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“…The software we are using (Visible Patient™, Strasbourg, France) allows investigating the anatomical landmarks, but also provides the useful functions such as simulation of the resection, volumetry of the segments and virtual identification of safety margins. Results and benefits of preoperative modelization have been widely reported (5,13) and it has been shown that concordance between radiological images and intraoperative findings is superior to 95% (14). Three-D printing, if available, is also an option (15,16).…”

Section: Anatomical Difficultiesmentioning

confidence: 99%

Thoracoscopic complex basilar segmentectomies: an analysis of 63 procedures

Gossot¹,

Mariolo²,

Grigoroiu³

et al. 2021

J Thorac Dis

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Background: Thoracoscopic complex basilar segmentectomies are technically demanding and challenging.We review our experience to check whether this complexity can lead to specific surgical issues or increased post-operative morbidity. Methods: Complex basilar segmentectomies were defined as the anatomical resection of at least one segment composing the basilar pyramid, excluding S 6. Data of patients who had an intention-to-treat thoracoscopic complex basilar segmentectomy were retrospectively collected from 2007 to 2019: indications, preoperative assessment, clinical features, operative technical aspects and early post-operative outcome.Results: Sixty-three patients, 26 men (41%) and 37 women (59%) with a median age of 66 years and a median body mass index (BMI) of 26 kg/m2 were included. Interventions performed were mostly S 9+10 (n=32)and S 8 (n=12) segmentectomies. Forty-five planned operations (71%) were completed. Extension to a larger resection was necessary in 17 patients (27%) and 4 patients underwent conversion to open surgery (6%).Median operative time was 168 minutes with a median intraoperative bleeding of 30 mL. Complications occurred in 11 patients (17%). There was no mortality. Median length of pleural drainage was 2 days (range, 1-2 days) and median hospital stay 4 days. Conclusions: The extension rate of complex basilar segmentectomy is higher than that of other sublobar resections but their post-operative morbidity is identical.

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Precise Anatomical Sublobar Resection Using a 3D Medical Image Analyzer and Fluorescence-Guided Surgery With Transbronchial Instillation of Indocyanine Green

Cited by 29 publications

References 10 publications

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

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

Fluorescence visualization of the intersegmental plane by bronchoscopic instillation of indocyanine green into the targeted segmental bronchus: determination of the optimal settings

Thoracoscopic complex basilar segmentectomies: an analysis of 63 procedures

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