Indocyanine green fluorescence identification of the intersegmental plane by preferentially ligating the target pulmonary vein during thoracoscopic segmentectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SUN Yungang ^1,2,3 , ZHANG Qiang ^1,2,3 , ZHUANG Yu ^1,2,3 , WANG Zhao ^1,2,3 , JIAO Siyang ^1,2,3 , YAO Mengxu ^1,2,3 ,  SHAO Feng ^1,2,3

1. Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing, 210029, P. R. China;
2. Department of Thoracic Surgery, Brain Hospital Affiliated to Nanjing Medical University, Nanjing, 210029, P. R. China;
3. 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 vein; fluorescence; indocyanine green; pulmonary circulation

DOI：

10.7507/1007-4848.202307029

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Objective To explore the feasibility and accuracy of using indocyanine green fluorescence (ICGF) to identify the intersegmental plane after ligation of the target pulmonary vein during thoracoscopic segmentectomy. Methods From December 2022 to June 2023, the patients with pulmonary nodules undergoing video-assisted thoracoscopic anatomical segmentectomy with intersegmental plane displayed using ICGF after ligation of the target pulmonary vein by the same medical team in our hospital were collected. Preoperative three-dimensional reconstruction was used to identify the target segment where the pulmonary nodule was located and the anatomical structure of the arteries, veins, and bronchi in the target segment. The intersegmental plane was first determined by the inflation-deflation method after the target pulmonary vein was ligated during the operation. During the waiting period, the target artery and bronchus could be separated but not cut off. The inflation-deflation boundary was marked by electrocoagulation, and then ICGF was injected via peripheral vein to identify the intersegmental plane again, and the consistency of the two intersegmental planes was finally evaluated. Results Finally 32 patients were collected, including 14 males and 18 females, with an average age of 58.69±11.84 years, ranging from 25 to 76 years. The intersegmental plane determined by inflation-deflation method was basically consistent with ICGF method in all patients. All the 32 patients successfully completed uniportal thoracoscopic segmentectomy without ICGF-related complications or perioperative death. The average operation time was 98.59±20.72 min, the average intraoperative blood loss was 45.31±35.65 mL, and the average postoperative chest tube duration was 3.50±1.16 days. The average postoperative hospital stay was 4.66±1.29 days, and the average tumor margin width was 26.96±5.86 mm. Conclusion The ICGF can safely and accurately identify the intersegmental plane by target pulmonary venous preferential ligation in thoracoscopic segmentectomy, which is a useful exploration and important supplement to the simplified thoracoscopic anatomical segmentectomy.

Citation： SUN Yungang, ZHANG Qiang, ZHUANG Yu, WANG Zhao, JIAO Siyang, YAO Mengxu, SHAO Feng. Indocyanine green fluorescence identification of the intersegmental plane by preferentially ligating the target pulmonary vein during thoracoscopic segmentectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(10): 1428-1433. doi: 10.7507/1007-4848.202307029 Copy

1.	Zhang M, Mao N, Wu QC, et al. A novel method for distinguishing the intersegmental plane: Pulmonary circulation single-blocking. J Thorac Dis, 2021, 13(1): 362-365.
2.	Zhang M, Wu QC, Ge MJ. The VVBA method for thoracoscopic right middle lobe segmentectomy. Gen Thorac Cardiovasc Surg, 2021, 69(1): 175-177.
3.	Zhang M, Mao N, Wu QC, et al. Vein or artery-first resection in right middle lobe segmentectomy: Which preserves more lung? Interact Cardiovasc Thorac Surg, 2021, 32(6): 993-995.
4.	Fu HH, Feng Z, Li M, et al. The arterial-ligation-alone method for identifying the intersegmental plane during thoracoscopic anatomic segmentectomy. J Thorac Dis, 2020, 12(5): 2343-2351.
5.	He H, Zhao H, Ma L, et al. Identification of the intersegmental plane by arterial ligation method during thoracoscopic segmentectomy. J Cardiothorac Surg, 2022, 17(1): 281.
6.	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.
7.	Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
8.	Altorki N, Wang X, Kozono D, et al. Lobar or sublobar resection for peripheral stage ⅠA non-small-cell lung cancer. N Engl J Med, 2023, 388(6): 489-498.
9.	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.
10.	Kamel MK, Rahouma M, Lee B, et al. Segmentectomy is equivalent to lobectomy in hypermetabolic clinical stage ⅠA lung adenocarcinomas. Ann Thorac Surg, 2019, 107(1): 217-223.
11.	Wu W, He Z, Xu J, et al. Anatomical pulmonary sublobar resection based on subsegment. Ann Thorac Surg, 2021, 111(6): e447-e450.
12.	Zhao Y, Xuan Y, Song J, et al. A novel technique for identification of the segments based on pulmonary artery plane combined with oxygen diffusing discrepancy. J Thorac Dis, 2019, 11(12): 5427-5432.
13.	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.
14.	Sun Y, Zhang Q, Wang Z, et al. Real-time image-guided indocyanine green fluorescence dual-visualization technique to measure the intraoperative resection margin during thoracoscopic segmentectomy. Asia Pac J Clin Oncol, 2023, 19(2): e39-e44.
15.	Fiorelli A, Forte S, Natale G, et al. Handling benign interlobar lymphadenopathy during thoracoscopic lobectomy. Thorac Cancer, 2021, 12(9): 1489-1492.
16.	Wei S, Guo C, He J, et al. Effect of vein-first vs artery-first surgical technique on circulating tumor cells and survival in patients with non-small cell lung cancer: A randomized clinical trial and registry-based propensity score matching analysis. JAMA Surg, 2019, 154(7): e190972.

1. Zhang M, Mao N, Wu QC, et al. A novel method for distinguishing the intersegmental plane: Pulmonary circulation single-blocking. J Thorac Dis, 2021, 13(1): 362-365.
2. Zhang M, Wu QC, Ge MJ. The VVBA method for thoracoscopic right middle lobe segmentectomy. Gen Thorac Cardiovasc Surg, 2021, 69(1): 175-177.
3. Zhang M, Mao N, Wu QC, et al. Vein or artery-first resection in right middle lobe segmentectomy: Which preserves more lung? Interact Cardiovasc Thorac Surg, 2021, 32(6): 993-995.
4. Fu HH, Feng Z, Li M, et al. The arterial-ligation-alone method for identifying the intersegmental plane during thoracoscopic anatomic segmentectomy. J Thorac Dis, 2020, 12(5): 2343-2351.
5. He H, Zhao H, Ma L, et al. Identification of the intersegmental plane by arterial ligation method during thoracoscopic segmentectomy. J Cardiothorac Surg, 2022, 17(1): 281.
6. 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.
7. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
8. Altorki N, Wang X, Kozono D, et al. Lobar or sublobar resection for peripheral stage ⅠA non-small-cell lung cancer. N Engl J Med, 2023, 388(6): 489-498.
9. 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.
10. Kamel MK, Rahouma M, Lee B, et al. Segmentectomy is equivalent to lobectomy in hypermetabolic clinical stage ⅠA lung adenocarcinomas. Ann Thorac Surg, 2019, 107(1): 217-223.
11. Wu W, He Z, Xu J, et al. Anatomical pulmonary sublobar resection based on subsegment. Ann Thorac Surg, 2021, 111(6): e447-e450.
12. Zhao Y, Xuan Y, Song J, et al. A novel technique for identification of the segments based on pulmonary artery plane combined with oxygen diffusing discrepancy. J Thorac Dis, 2019, 11(12): 5427-5432.
13. 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.
14. Sun Y, Zhang Q, Wang Z, et al. Real-time image-guided indocyanine green fluorescence dual-visualization technique to measure the intraoperative resection margin during thoracoscopic segmentectomy. Asia Pac J Clin Oncol, 2023, 19(2): e39-e44.
15. Fiorelli A, Forte S, Natale G, et al. Handling benign interlobar lymphadenopathy during thoracoscopic lobectomy. Thorac Cancer, 2021, 12(9): 1489-1492.
16. Wei S, Guo C, He J, et al. Effect of vein-first vs artery-first surgical technique on circulating tumor cells and survival in patients with non-small cell lung cancer: A randomized clinical trial and registry-based propensity score matching analysis. JAMA Surg, 2019, 154(7): e190972.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Indocyanine green fluorescence identification of the intersegmental plane by preferentially ligating the target pulmonary vein during thoracoscopic segmentectomy

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