Recent fluorescence-based optical imaging for video-assisted thoracoscopic surgery segmentectomy

Abstract

Background: The importance of fluorescence-based optical imaging in various fields of surgery is increasing. This is a prospective cohort study aimed to investigate the feasibility and efficacy of indocyaninegreen fluorescence (ICGF)-based navigation for near-infrared (NIR) thoracoscopic segmentectomy. Methods: ICGF-based video-assisted thoracoscopic surgery (VATS) segmentectomy was performed in 149 patients. Each patient underwent preoperative evaluation by multidetector-row computed tomography (MDCT), which provided three-dimensional simulations of vascular structures, segmental bronchi, and lung tumor. During the procedure, low-dose ICG (0.25 mg/kg) was injected systemically after the target segmental pulmonary arteries and bronchus were divided. Under NIR-thoracoscopic guidance, an ICG fluorescent line was marked by electric scalpel, followed by division of lung parenchyma along the line by electric scalpel or endoscopic staples. Results: An intersegmental line of ICGF was visible in 98% of patients, even with the use of low-dose ICG. Neither ICG-related adverse events nor procedure-related major complications occurred. The 5-year overall (OS) and recurrence-free survival (RFS) rates were 91.8% and 98%, respectively. Localized recurrence at the resected site did not occur in any patient. Conclusions: ICGF-based navigation for NIR VATS segmentectomy for patients with lung cancer is feasible and effective.

Indocyanine green imaging for pulmonary segmentectomy

“…ICG was reconstituted into distilled water to produce a 2.5 mg/mL solution, and a volume of 0.25 mg/kg was injected into the peripheral vein, 10 , 11 followed by a 10-mL flush of sterile normal saline. After injection, the surgical field was visualized by near-infrared fluorescence imaging using a fluorescence imaging camera (1588 or 1688 AIM Camera System, Stryker, Kalamazoo, Mich).…”

Research on the application of uniportal video-assisted thoracoscopic segmental resection of the lung in elderly patients with non-small cell lung cancer aged over 65 years.

“…If the pulmonary artery of the target pulmonary segment is not completely transected, the intersegmental boundary is also inaccurate, and the hilum cannot be lifted, causing some lung segment tissues, which should be retained, to be resected [20]. Moreover, if the pulmonary veins that are not part of the target lung segment are transected, it will cause venous return disorder, postoperative hemoptysis, and a second operation is required for lobectomy in severe cases [21]. If the pulmonary vein of the target lung segment is not completely transected, misjudgment will occur when judging the intersegmental boundary based on the intersegmental veins, and the lung tissue that should have been resected may be retained [22,23].…”

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

“…In Table 3 is showed a review of the use of ICG for the intersegmental plane identi cation. 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].…”

“…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]. The minimum time for migration and detection was seconds [23,25,29], the maximum was few minutes [26,28].…”