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 indocyanine-green 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.

Keywords: Video-assisted thoracoscopic surgery (VATS); indocyanine green (ICG); near-infrared thoracoscopy (NIR thoracoscopy); segmentectomy.

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1

Preoperative evaluation. (A) Thin-slice computed tomography (CT) shows a partly solid ground-glass nodule (GGN) in the left S1+2 segments. (B) Three-dimensional (3D)-CT simulation shows tumor location, segmental arteries, and segmental bronchus. (C) 3D-CT shows intersegmental vein. (D) Virtual intersegmental plane is created based on the segmental artery.

Figure 2

Port placement. Indocyanine green-fluorescence (ICGF)-based navigation for video-assisted thoracoscopic surgery (VATS) segmentectomy is performed via 4 incisions.

Figure 3

Intraoperative indocyanine green-fluorescence (ICGF) images. Left S1+2 appear dark, and residual segment appears bright. The border between these 2 regions is recognized as the intersegmental plane (arrowheads).

Figure 4

Final aspect after indocyanine green-fluorescence (ICGF)-based navigation for video-assisted thoracoscopic surgery (VATS) segmentectomy of left S1+2.

Figure 5

Overall survival (OS) analysis of patients with primary lung cancer by the Kaplan-Meier method.

Figure 6

Recurrence-free survival (RFS) analysis of patients with primary lung cancer by the Kaplan-Meier method.

Figure 7

Near-infrared thoracoscopy. (A) Pinpoint; Novadaq, Kalamazoo, MI, USA. Intersegmental plane (arrows). (B) Visera Elite II; Olympus, Tokyo, Japan. Clear contrast is observed, with the background also apparent. Intersegmental plane (arrows).