Application of indocyanine green fluorescence dual-visualization technique in evaluating intraoperative tumor margins during the thoracoscopic segmentectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SUN Yungang ^1,2 , ZHANG Qiang ^1,2 , WANG Zhao ^1,2 ,  SHAO Feng ^1,2

1. Department of Thoracic Surgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, P. R. China;
2. Pulmonary Nodule Diagnosis and Treatment Research Center, Nanjing Medical University, Nanjing, 210029, P. R. China;

Corresponding author：

SHAO Feng, Email: doctorshao1982@sina.com

Keywords：

Segmentectomy; pulmonary nodule; fluorescence; indocyanine green; thoracoscopy

DOI：

10.7507/1007-4848.202108077

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To analyze the effect of indocyanine green (ICG) fluorescence dual-visualization technique on evaluating tumor margins during the thoracoscopic segmentectomy. Methods A total of 36 patients who underwent thoracoscopic anatomical segmentectomy using ICG fluorescence dual-visualization technique in our hospital from December 2020 to June 2021 were retrospectively included. There were 15 males and 21 females aged from 20 to 69 years. The clinical data of the patients were retrospectively analyzed. Results The ICG fluorescence dual-visualization technique clearly showed the position of lung nodules and the plane boundary line between segments during the operation. There was no ICG-related complication. The average operation time was 98.6±21.3 min, and the average intraoperative bleeding amount was 47.1±35.3 mL, the average postoperative drainage tube placement time was 3.3±2.8 d, the average postoperative hospital stay was 5.4±1.8 d, and the average tumor resection distance was 2.6±0.7 cm. There was no perioperative period death, and one patient suffered a persistent postoperative air leak. Conclusion The ICG fluorescence dual-visualization technique is safe and feasible for evaluating the tumor margins during thoracoscopic segmentectomy. It simplifies the surgical procedure, shortens the operation time, ensures sufficient tumor margins, and reserves healthy pulmonary parenchyma to the utmost extent, providing reliable technical support for thoracoscopic anatomical segmentectomy.

Citation： SUN Yungang, ZHANG Qiang, WANG Zhao, SHAO Feng. Application of indocyanine green fluorescence dual-visualization technique in evaluating intraoperative tumor margins during the thoracoscopic segmentectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(10): 1319-1322. doi: 10.7507/1007-4848.202108077 Copy

1.	Wu WB, Xia Y, Pan XL, et al. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
2.	Kamel MK, Rahouma M, Lee B, et al. Segmentectomy is equivalent to lobectomy in hypermetabolic clinical stageⅠA Lung adenocarcinomas. Ann Thorac Surg, 2019, 107(1): 217-23.
3.	Tsubokawa N, Tsutani Y, Miyata Y, et al. Segmentectomy versus lobectomy for radiologically pure solid clinical T1a-bN0M0 lung cancer. World J Surg, 2018, 42(8): 2493-2501.
4.	陈亮, 王俊, 吴卫兵, 等. 胸腔镜精准肺段切除术技术流程和质量控制. 中国胸心血管外科临床杂志, 2019, 26(1): 21-28.
5.	陈亮, 吴卫兵. 胸腔镜解剖性肺段切除术技术要点. 中国肺癌杂志, 2016, 19(6): 377-381.
6.	Wang J, Xu X, Wen W, et al. Modified method for distinguishing the intersegmental border for lung segmentectomy. Thorac Cancer, 2018, 9(2): 330-333.
7.	Nomori H, Shiraishi A, Cong Y, et al. Differences in postoperative changes in pulmonary functions following segmentectomy compared with lobectomy. Eur J Cardiothorac Surg, 2018, 53(3): 640-647.
8.	Suzuki H, Morimoto J, Mizobuchi T, et al. Does segmentectomy really preserve the pulmonary function better than lobectomy for patients with early-stage lung cancer? Surg Today, 2017, 47(4): 463-469.
9.	Gu Z, Wang H, Mao T, et al. Pulmonary function changes after different extent of pulmonary resection under video-assisted thoracic surgery. J Thorac Dis, 2018, 10(4): 2331-2337.
10.	王礼同, 汤晓明, 黄华, 等. 电视胸腔镜手术前CT引导下亚甲蓝和/或Hookwire定位肺磨玻璃结节. 中国医学影像技术, 2019, 35(8): 1220-1223.
11.	赵常坤, 张勇, 王巍炜. 肺磨玻璃结节胸腔镜术前定位的研究进展. 医学综述, 2019, 25(16): 3274-3278.
12.	Rho J, Lee JW, Quan YH, et al. Fluorescent and iodized emulsion for preoperative localization of pulmonary nodules. Ann Surg, 2021, 273(5): 989-996.
13.	Sun Y, Zhang Q, Wang Z, et al. 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? Thorac Cancer, 2019, 10(10): 2013-2021.
14.	Sun Y, Zhang Q, Wang Z, et al. 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. Thorac Cancer, 2021, 12(9): 1407-1414.
15.	Motono N, Iwai S, Funasaki A, et al. Low-dose indocyanine green fluorescence-navigated segmentectomy: Prospective analysis of 20 cases and review of previous reports. J Thorac Dis, 2019, 11(3): 702-707.

1. Wu WB, Xia Y, Pan XL, et al. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
2. Kamel MK, Rahouma M, Lee B, et al. Segmentectomy is equivalent to lobectomy in hypermetabolic clinical stageⅠA Lung adenocarcinomas. Ann Thorac Surg, 2019, 107(1): 217-23.
3. Tsubokawa N, Tsutani Y, Miyata Y, et al. Segmentectomy versus lobectomy for radiologically pure solid clinical T1a-bN0M0 lung cancer. World J Surg, 2018, 42(8): 2493-2501.
4. 陈亮, 王俊, 吴卫兵, 等. 胸腔镜精准肺段切除术技术流程和质量控制. 中国胸心血管外科临床杂志, 2019, 26(1): 21-28.
5. 陈亮, 吴卫兵. 胸腔镜解剖性肺段切除术技术要点. 中国肺癌杂志, 2016, 19(6): 377-381.
6. Wang J, Xu X, Wen W, et al. Modified method for distinguishing the intersegmental border for lung segmentectomy. Thorac Cancer, 2018, 9(2): 330-333.
7. Nomori H, Shiraishi A, Cong Y, et al. Differences in postoperative changes in pulmonary functions following segmentectomy compared with lobectomy. Eur J Cardiothorac Surg, 2018, 53(3): 640-647.
8. Suzuki H, Morimoto J, Mizobuchi T, et al. Does segmentectomy really preserve the pulmonary function better than lobectomy for patients with early-stage lung cancer? Surg Today, 2017, 47(4): 463-469.
9. Gu Z, Wang H, Mao T, et al. Pulmonary function changes after different extent of pulmonary resection under video-assisted thoracic surgery. J Thorac Dis, 2018, 10(4): 2331-2337.
10. 王礼同, 汤晓明, 黄华, 等. 电视胸腔镜手术前CT引导下亚甲蓝和/或Hookwire定位肺磨玻璃结节. 中国医学影像技术, 2019, 35(8): 1220-1223.
11. 赵常坤, 张勇, 王巍炜. 肺磨玻璃结节胸腔镜术前定位的研究进展. 医学综述, 2019, 25(16): 3274-3278.
12. Rho J, Lee JW, Quan YH, et al. Fluorescent and iodized emulsion for preoperative localization of pulmonary nodules. Ann Surg, 2021, 273(5): 989-996.
13. Sun Y, Zhang Q, Wang Z, et al. 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? Thorac Cancer, 2019, 10(10): 2013-2021.
14. Sun Y, Zhang Q, Wang Z, et al. 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. Thorac Cancer, 2021, 12(9): 1407-1414.
15. Motono N, Iwai S, Funasaki A, et al. Low-dose indocyanine green fluorescence-navigated segmentectomy: Prospective analysis of 20 cases and review of previous reports. J Thorac Dis, 2019, 11(3): 702-707.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of indocyanine green fluorescence dual-visualization technique in evaluating intraoperative tumor margins during the thoracoscopic segmentectomy

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