Comparative study of fluorescence and inflation-deflation methods in defining the intersegmental plane in thoracoscopic anatomical lung segmentectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHAO Feng , SUN Yungang , WANG Zhao , LIU Zhengcheng , CAO Hui , SHI Ye ,  YANG Rusong

Department of Thoracic Surgery, Nanjing Chest Hospital Affiliated to Southeast University, Nanjing, 210029, P.R. China;

Corresponding?author：

YANG Rusong, Email: njyrs_md@188.com

Keywords：

Lung segmentectomy; lung cancer; single-port thoracoscope; fluorescence; inflation-deflation

DOI：

10.7507/1007-4848.201812022

Video：

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Objective To analyze the feasibility, advantages and disadvantages of the fluorescence method and the inflation-deflation method in defining the intersegmental plane during thoracoscopic lung segmental resection.Methods From February to October 2018, 60 patients underwent thoracoscopic anatomical segmentectomy in Thoracic Surgery Department of Nanjing Chest Hospital, with 28 males and 32 females, aged from 25 to 82 years. Three-dimension computed tomography bronchography and angiography was used to reconstruct pulmonary vessels, bronchus and virtual intersegmental plane. Among them, 20 patients used the fluorescence method to define the intersegmental plane, and the other 40 patients used the traditional inflation-deflation method to define the intersegmental plane.Results Fluorescent injection of indocyanine green (ICG) showed a clear intersegmental line with a duration sufficient to complete the label. With the fluorescence method, the intersegmental plane occurrence time was significantly shortened (10.75±3.78 s vs. 988.00±314.24 s, P<0.001) and had satisfactory repeatability. The lungs did not need to be inflated, which was convenient for the operation. And the operation time was shortened (108.75±31.28 min vs 138.00±32.47 min, P=0.002). No obvious ICG injection-related concurrency symptoms was found.Conclusion Compared with the traditional inflation-deflation method, the fluorescence method can display the intersegmental line quickly, accurately and clearly, reduce the difficulty of surgery, shorten the operation time, and provide reliable technical support for thoracoscopic anatomical segmentectomy. The fluorescence is a safe and effective method that is worthy of clinical application.

Citation： SHAO Feng, SUN Yungang, WANG Zhao, LIU Zhengcheng, CAO Hui, SHI Ye, YANG Rusong. Comparative study of fluorescence and inflation-deflation methods in defining the intersegmental plane in thoracoscopic anatomical lung segmentectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(9): 899-904. doi: 10.7507/1007-4848.201812022 Copy

1.	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.
2.	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.
3.	Wu WB, Xu XF, Wen W, et al. Three-dimensional computed tomography bronchography and angiography in the preoperative evaluation of thoracoscopic segmentectomy and subsegmentectomy. J Thorac Dis, 2016, 8(Suppl 9): S710-S715.
4.	Wang K, Wang Z, Duan G, et al. Application of 3D-CT reconstruction combined with indocyanine green fluorescence in anatomical thoracoscopic segmentectomy. Chinese General Practice, 2018, 21(24): 300.
5.	Atkins BZ, Harpole DH Jr, Mangum JH, et al. Pulmonary segmentectomy by thoracotomy or thoracoscopy: reduced hospital length of stay with a minimally-invasive approach. Ann Thorac Surg, 2007, 84(4): 1107-1112.
6.	Kasai Y, Tarumi S, Chang SS, et al. Clinical trial of new methods for identifying lung intersegmental borders using infrared thoracoscopy with indocyanine green: comparative analysis of 2- and 1-wavelength methods. Eur J Cardiothorac Surg, 2013, 44(6): 1103-1107.
7.	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.
8.	Tarumi S, Misaki N, Kasai Y, et al. Clinical trial of video-assisted thoracoscopic segmentectomy using infrared thoracoscopy with indocyanine green. Eur J Cardiothorac Surg, 2014, 46(1): 112-115.
9.	Moon MH, Moon YK, Moon SW. Segmentectomy versus lobectomy in early non-small cell lung cancer of 2 cm or less in size: A population-based study. Respirology, 2018, 23(7): 695-703.
10.	Aberle DR, DeMello S, Berg CD, et al. Results of the two incidence screenings in the National Lung Screening Trial. N Engl J Med, 2013, 369(10): 920-931.
11.	Nomori H, Mori T, Ikeda K, et al. Segmentectomy for selected cT1N0M0 non-small cell lung cancer: a prospective study at a single institute. J Thorac Cardiovasc Surg, 2012, 144(1): 87-93.
12.	Schuchert MJ, Abbas G, Awais O, et al. Anatomic segmentectomy for the solitary pulmonary nodule and early-stage lung cancer. Ann Thorac Surg, 2012, 93(6): 1780-1785.
13.	Landreneau RJ, Normolle DP, Christie NA, et al. Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stage I non-small-cell lung cancer: a propensity-matched analysis. J Clin Oncol, 2014, 32(23): 2449-2455.
14.	Tsutani Y, Miyata Y, Nakayama H, et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage IA lung adenocarcinoma: wedge resection or segmentectomy. Chest, 2014, 145(1): 66-71.
15.	Dziedzic R, Rzyman W. Lobectomy versus segmentectomy and wedge resection in the treatment of stage I non-small cell lung cancer. J Thorac Dis, 2018, 10(3): E234-E235.
16.	Hou B, Deng XF, Zhou D, et al. Segmentectomy versus wedge resection for the treatment of high-risk operable patients with stage I non-small cell lung cancer: a meta-analysis. Ther Adv Respir Dis, 2016, 10(5): 435-443.
17.	Liu Z, Yang R, Shao F. Comparison of postoperative pain and recovery between single-port and two-port thoracoscopic lobectomy for lung cancer. Thorac Cardiovasc Surg, 2019, 67(2): 142-146.
18.	Lin Y, Zheng W, Zhu Y, et al. Comparison of treatment outcomes between single-port video-assisted thoracoscopic anatomic segmentectomy and lobectomy for non-small cell lung cancer of early-stage: a retrospective observational study. J Thorac Dis, 2016, 8(6): 1290-1296.
19.	Gonzalez-Rivas D, Mendez L, Delgado M, et al. Uniportal video-assisted thoracoscopic anatomic segmentectomy. J Thorac Dis, 2013 Aug; 5 Suppl 3: S226-33.
20.	Kim HK, Han KN. Uniportal video-assisted thoracoscopic surgery segmentectomy. Thorac Surg Clin, 2017, 27(4): 387-398.
21.	Okada M, Mimura T, Ikegaki J, et al. A novel video-assisted anatomic segmentectomy technique: selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. J Thorac Cardiovasc Surg, 2007, 133(3): 753-758.
22.	Oh S, Suzuki K, Miyasaka Y, et al. New technique for lung segmentectomy using indocyanine green injection. Ann Thorac Surg, 2013, 95(6): 2188-2190.
23.	翟榮, 徐心峰, 王俊, 等. 肺段切除術中改良膨脹萎陷法影響因素研究. 南京醫科大學學報(自然科學版), 2018, 38(8): 1136-1139.
24.	馬永富, 姚潔, 劉陽, 等. 術前 3D 重建術中 CT 定位熒光胸腔鏡下右肺下葉外后基底段精準切除術. 中華腔鏡外科雜志(電子版), 2018, 11(3): 180-182.
25.	王康武, 王祖義, 段貴新, 等. 三維 CT 重建聯合吲哚菁綠熒光導航在胸腔鏡解剖性肺段切除術中的應用. 中國全科醫學, 2018, 21(24): 3001-3004.
26.	Desmettre T, Devoisselle JM, Mordon S. Fluorescence properties and metabolic features of indocyanine green (ICG) as related to angiography. Surv Ophthalmol, 2000, 45(1): 15-27.

1. 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.
2. 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.
3. Wu WB, Xu XF, Wen W, et al. Three-dimensional computed tomography bronchography and angiography in the preoperative evaluation of thoracoscopic segmentectomy and subsegmentectomy. J Thorac Dis, 2016, 8(Suppl 9): S710-S715.
4. Wang K, Wang Z, Duan G, et al. Application of 3D-CT reconstruction combined with indocyanine green fluorescence in anatomical thoracoscopic segmentectomy. Chinese General Practice, 2018, 21(24): 300.
5. Atkins BZ, Harpole DH Jr, Mangum JH, et al. Pulmonary segmentectomy by thoracotomy or thoracoscopy: reduced hospital length of stay with a minimally-invasive approach. Ann Thorac Surg, 2007, 84(4): 1107-1112.
6. Kasai Y, Tarumi S, Chang SS, et al. Clinical trial of new methods for identifying lung intersegmental borders using infrared thoracoscopy with indocyanine green: comparative analysis of 2- and 1-wavelength methods. Eur J Cardiothorac Surg, 2013, 44(6): 1103-1107.
7. 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.
8. Tarumi S, Misaki N, Kasai Y, et al. Clinical trial of video-assisted thoracoscopic segmentectomy using infrared thoracoscopy with indocyanine green. Eur J Cardiothorac Surg, 2014, 46(1): 112-115.
9. Moon MH, Moon YK, Moon SW. Segmentectomy versus lobectomy in early non-small cell lung cancer of 2 cm or less in size: A population-based study. Respirology, 2018, 23(7): 695-703.
10. Aberle DR, DeMello S, Berg CD, et al. Results of the two incidence screenings in the National Lung Screening Trial. N Engl J Med, 2013, 369(10): 920-931.
11. Nomori H, Mori T, Ikeda K, et al. Segmentectomy for selected cT1N0M0 non-small cell lung cancer: a prospective study at a single institute. J Thorac Cardiovasc Surg, 2012, 144(1): 87-93.
12. Schuchert MJ, Abbas G, Awais O, et al. Anatomic segmentectomy for the solitary pulmonary nodule and early-stage lung cancer. Ann Thorac Surg, 2012, 93(6): 1780-1785.
13. Landreneau RJ, Normolle DP, Christie NA, et al. Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stage I non-small-cell lung cancer: a propensity-matched analysis. J Clin Oncol, 2014, 32(23): 2449-2455.
14. Tsutani Y, Miyata Y, Nakayama H, et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage IA lung adenocarcinoma: wedge resection or segmentectomy. Chest, 2014, 145(1): 66-71.
15. Dziedzic R, Rzyman W. Lobectomy versus segmentectomy and wedge resection in the treatment of stage I non-small cell lung cancer. J Thorac Dis, 2018, 10(3): E234-E235.
16. Hou B, Deng XF, Zhou D, et al. Segmentectomy versus wedge resection for the treatment of high-risk operable patients with stage I non-small cell lung cancer: a meta-analysis. Ther Adv Respir Dis, 2016, 10(5): 435-443.
17. Liu Z, Yang R, Shao F. Comparison of postoperative pain and recovery between single-port and two-port thoracoscopic lobectomy for lung cancer. Thorac Cardiovasc Surg, 2019, 67(2): 142-146.
18. Lin Y, Zheng W, Zhu Y, et al. Comparison of treatment outcomes between single-port video-assisted thoracoscopic anatomic segmentectomy and lobectomy for non-small cell lung cancer of early-stage: a retrospective observational study. J Thorac Dis, 2016, 8(6): 1290-1296.
19. Gonzalez-Rivas D, Mendez L, Delgado M, et al. Uniportal video-assisted thoracoscopic anatomic segmentectomy. J Thorac Dis, 2013 Aug; 5 Suppl 3: S226-33.
20. Kim HK, Han KN. Uniportal video-assisted thoracoscopic surgery segmentectomy. Thorac Surg Clin, 2017, 27(4): 387-398.
21. Okada M, Mimura T, Ikegaki J, et al. A novel video-assisted anatomic segmentectomy technique: selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. J Thorac Cardiovasc Surg, 2007, 133(3): 753-758.
22. Oh S, Suzuki K, Miyasaka Y, et al. New technique for lung segmentectomy using indocyanine green injection. Ann Thorac Surg, 2013, 95(6): 2188-2190.
23. 翟榮, 徐心峰, 王俊, 等. 肺段切除術中改良膨脹萎陷法影響因素研究. 南京醫科大學學報(自然科學版), 2018, 38(8): 1136-1139.
24. 馬永富, 姚潔, 劉陽, 等. 術前 3D 重建術中 CT 定位熒光胸腔鏡下右肺下葉外后基底段精準切除術. 中華腔鏡外科雜志(電子版), 2018, 11(3): 180-182.
25. 王康武, 王祖義, 段貴新, 等. 三維 CT 重建聯合吲哚菁綠熒光導航在胸腔鏡解剖性肺段切除術中的應用. 中國全科醫學, 2018, 21(24): 3001-3004.
26. Desmettre T, Devoisselle JM, Mordon S. Fluorescence properties and metabolic features of indocyanine green (ICG) as related to angiography. Surv Ophthalmol, 2000, 45(1): 15-27.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparative study of fluorescence and inflation-deflation methods in defining the intersegmental plane in thoracoscopic anatomical lung segmentectomy

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