Application of three-dimensional computed tomography-bronchography and angiography combined with indocyanine green reverse staining in video-assisted thoracic segmentectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HU Junxi ¹ , GAO Xianglong ¹ , KONG Hao ¹ ,  SHU Yusheng ^1,2

1. Yangzhou University Medical College, Yangzhou, 225000, Jiangsu, P. R. China;
2. Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, 225000, Jiangsu, P. R. China;

Corresponding author：

SHU Yusheng, Email: shuyusheng65@163.com

Keywords：

Three-dimensional computed tomography (3D-CT); bronchography and angiography; indocyanine green; near-infrared angiography; video-assisted thoracic surgery (VATS); segmentectomy; lung neoplasms

DOI：

10.7507/1007-4848.202108093

Video：

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Objective To evaluate the security and clinical value of the combination of three-dimensional computed tomography-bronchography and angiography (3D-CTBA) and indocyanine green (ICG) staining in video-assisted thoracic surgery (VATS) segmentectomy. Methods The clinical data of 125 patients who received VATS segmentectomy from January 2020 to January 2021 in our hospital were retrospectively analyzed. There were 40 (32.0%) males and 85 (68.0%) females with an average age of 54.8±11.1 years. Results The procedure was almost identical to the preoperative simulation. All intersegment planes were displayed successfully by ICG reverse staining method. There was no allergic patient. A total of 130 pathological specimens were obtained from the 125 patients. The mean operation time was 126.8±41.9 min, the time of first appearance of fluorescence was 22.7±4.9 s, the mean mark time was 65.6±20.3 s, the median blood loss was 20.0 (10.0-400.0) mL, the postoperative hospital stay was 5.6 (4.0-28.0) d, and the postoperative retention of chest tube time was 3.2 (2.0-25.0) d. Pathological results showed that microinvasive adenocarcinoma was the most common type (38.5%, 50/130), followed by invasive adenocarcinoma (36.9%, 48/130); there were 3 metastatic tumors (3/130, 2.3%).Conclusion The combination of 3D-CTBA and ICG reverse staining is proved to be a safe, necessary and feasible method. It solves the difficult work encountered in the procedure of segmentectomy, and it is worth popularizing and applying in clinic.

Citation： HU Junxi, GAO Xianglong, KONG Hao, SHU Yusheng. Application of three-dimensional computed tomography-bronchography and angiography combined with indocyanine green reverse staining in video-assisted thoracic segmentectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(10): 1290-1295. doi: 10.7507/1007-4848.202108093 Copy

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7.	Cao C, Manganas C, Ang SC, et al. Video-assisted thoracic surgery versus open thoracotomy for non-small cell lung cancer: A meta-analysis of propensity score-matched patients. Interact Cardiovasc Thorac Surg, 2013, 16(3): 244-249.
8.	Committee for Scientific Affairs, Sakata R, Fujii Y, et al. Thoracic and cardiovascular surgery in Japan during 2009: Annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg, 2011, 59(9): 636-667.
9.	Watanabe S, Arai K, Watanabe T, et al. Use of three-dimensional computed tomographic angiography of pulmonary vessels for lung resections. Ann Thorac Surg, 2003, 75(2): 388-392.
10.	Akiba T, Marushima H, Harada J, et al. Importance of preoperative imaging with 64-row three-dimensional multidetector computed tomography for safer video-assisted thoracic surgery in lung cancer. Surg Today, 2009, 39(10): 844-847.
11.	Ogawa M, Kosaka N, Choyke PL, et al. In vivo molecular imaging of cancer with a quenching near-infrared fluorescent probe using conjugates of monoclonal antibodies and indocyanine green. Cancer Res, 2009, 69(4): 1268-1272.
12.	Moody ED, Viskari PJ, Colyer CL. Non-covalent labeling of human serum albumin with indocyanine green: A study by capillary electrophoresis with diode laser-induced fluorescence detection. J Chromatogr B Biomed Sci Appl, 1999, 729(1-2): 55-64.
13.	Kokudo N, Ishizawa T. Clinical application of fluorescence imaging of liver cancer using indocyanine green. Liver Cancer, 2012, 1(1): 15-21.
14.	Misaki N, Chang SS, Igai H, et al. New clinically applicable method for visualizing adjacent lung segments using an infrared thoracoscopy system. J Thorac Cardiovasc Surg, 2010, 140(4): 752-756.
15.	Tarumi S, Yokomise H. Video-assisted thoracoscopic segmentectomy using infrared thoracoscopy with indocyanine green. Kyobu Geka, 2016, 69(8): 671-675.
16.	Oizumi H, Kato H, Endoh M, et al. Techniques to define segmental anatomy during segmentectomy. Ann Cardiothorac Surg, 2014, 3(2): 170-175.
17.	丁超. 单肺通气对局部脑氧饱和度的影响及其与POCD的关系. 北京协和医学院, 2012.
18.	Kuroda H, Yoshida T, Arimura T, et al. Novel development of spectra-A using indocyanine green for segmental boundary visibility in thoracoscopic segmentectomy. J Surg Res, 2018, 227: 228-233.
19.	Akiba T. Utility of three-dimensional computed tomography in general thoracic surgery. Gen Thorac Cardiovasc Surg, 2013, 61(12): 676-684.
20.	Abdelsattar ZM, Blackmon SH. Using novel technology to augment complex video-assisted thoracoscopic single basilar segmentectomy. J Thorac Dis, 2018, 10(Suppl 10): S1168-S1178.
21.	Yajima T, Shimizu K, Mogi A, et al. Pulmonary artery compression facilitates intersegmental border visualization. Ann Thorac Surg, 2019, 108(2): e141-e143.
22.	Pischik VG, Kovalenko A. The role of indocyanine green fluorescence for intersegmental plane identification during video-assisted thoracoscopic surgery segmentectomies. J Thorac Dis, 2018, 10(Suppl 31): S3704-S3711.
23.	Mun M, Okumura S, Nakao M, et al. Indocyanine green fluorescence-navigated thoracoscopic anatomical segmentectomy. J Vis Surg, 2017, 3: 80.

1. Barta JA, Powell CA, Wisnivesky JP. Global epidemiology of lung cancer. Ann Glob Health, 2019, 85(1): 8.
2. 郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
3. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung cancer study group. Ann Thorac Surg, 1995, 60(3): 615-622.
4. Davini F, Ricciardi S, Zirafa CC, et al. Treatment of pulmonary nodule: From VATS to RATS. J Vis Surg, 2018, 4: 36.
5. Wang Q, Jiang W, Wang L, et al. Treatment principle and surgical technique of pulmonary ground glass nodules. Zhonghua Zhong Liu Za Zhi, 2019, 41(1): 6-9.
6. 林凌, 赵珩. 意向性胸腔镜下解剖性肺段切除在早期肺癌中的应用. 临床外科杂志, 2017, 25(7): 495-497.
7. Cao C, Manganas C, Ang SC, et al. Video-assisted thoracic surgery versus open thoracotomy for non-small cell lung cancer: A meta-analysis of propensity score-matched patients. Interact Cardiovasc Thorac Surg, 2013, 16(3): 244-249.
8. Committee for Scientific Affairs, Sakata R, Fujii Y, et al. Thoracic and cardiovascular surgery in Japan during 2009: Annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg, 2011, 59(9): 636-667.
9. Watanabe S, Arai K, Watanabe T, et al. Use of three-dimensional computed tomographic angiography of pulmonary vessels for lung resections. Ann Thorac Surg, 2003, 75(2): 388-392.
10. Akiba T, Marushima H, Harada J, et al. Importance of preoperative imaging with 64-row three-dimensional multidetector computed tomography for safer video-assisted thoracic surgery in lung cancer. Surg Today, 2009, 39(10): 844-847.
11. Ogawa M, Kosaka N, Choyke PL, et al. In vivo molecular imaging of cancer with a quenching near-infrared fluorescent probe using conjugates of monoclonal antibodies and indocyanine green. Cancer Res, 2009, 69(4): 1268-1272.
12. Moody ED, Viskari PJ, Colyer CL. Non-covalent labeling of human serum albumin with indocyanine green: A study by capillary electrophoresis with diode laser-induced fluorescence detection. J Chromatogr B Biomed Sci Appl, 1999, 729(1-2): 55-64.
13. Kokudo N, Ishizawa T. Clinical application of fluorescence imaging of liver cancer using indocyanine green. Liver Cancer, 2012, 1(1): 15-21.
14. Misaki N, Chang SS, Igai H, et al. New clinically applicable method for visualizing adjacent lung segments using an infrared thoracoscopy system. J Thorac Cardiovasc Surg, 2010, 140(4): 752-756.
15. Tarumi S, Yokomise H. Video-assisted thoracoscopic segmentectomy using infrared thoracoscopy with indocyanine green. Kyobu Geka, 2016, 69(8): 671-675.
16. Oizumi H, Kato H, Endoh M, et al. Techniques to define segmental anatomy during segmentectomy. Ann Cardiothorac Surg, 2014, 3(2): 170-175.
17. 丁超. 单肺通气对局部脑氧饱和度的影响及其与POCD的关系. 北京协和医学院, 2012.
18. Kuroda H, Yoshida T, Arimura T, et al. Novel development of spectra-A using indocyanine green for segmental boundary visibility in thoracoscopic segmentectomy. J Surg Res, 2018, 227: 228-233.
19. Akiba T. Utility of three-dimensional computed tomography in general thoracic surgery. Gen Thorac Cardiovasc Surg, 2013, 61(12): 676-684.
20. Abdelsattar ZM, Blackmon SH. Using novel technology to augment complex video-assisted thoracoscopic single basilar segmentectomy. J Thorac Dis, 2018, 10(Suppl 10): S1168-S1178.
21. Yajima T, Shimizu K, Mogi A, et al. Pulmonary artery compression facilitates intersegmental border visualization. Ann Thorac Surg, 2019, 108(2): e141-e143.
22. Pischik VG, Kovalenko A. The role of indocyanine green fluorescence for intersegmental plane identification during video-assisted thoracoscopic surgery segmentectomies. J Thorac Dis, 2018, 10(Suppl 31): S3704-S3711.
23. Mun M, Okumura S, Nakao M, et al. Indocyanine green fluorescence-navigated thoracoscopic anatomical segmentectomy. J Vis Surg, 2017, 3: 80.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of three-dimensional computed tomography-bronchography and angiography combined with indocyanine green reverse staining in video-assisted thoracic segmentectomy

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