Technique, Outcomes With Navigational Bronchoscopy Using Indocyanine Green for Robotic Segmentectomy

Abstract

Background: The objectives of this study were to present outcomes of robotic segmentectomy and the investigators' preferred technique for nodule localization using indocyanine green both bronchoscopically and intravenously.

Methods: This study was a retrospective review of a consecutive series of patients scheduled for robotic segmentectomy from a single surgeon's prospectively collected database.

Results: Between January 2010 and October 2018, there were 245 consecutive patients who underwent planned robotic segmentectomy by one surgeon. Of these 245 patients, 93 (38%) received indocyanine green by electromagnetic navigational bronchoscopy, and all 245 received intravenous indocyanine green. Median time for navigational bronchoscopy was 9 minutes. Navigational bronchoscopy with indocyanine green correctly identified the lesion in 80 cases (86%). The preferred technique was as follows: 0.5 mL of 25 mg of indocyanine green diluted in 10 mL of sterile water given bronchoscopically, followed by a 0.5-mL saline flush, staying at least 4 mm from the pleural surface. The remaining 9.5 mL of indocyanine green was administered intravenously after pulmonary artery ligation. An R0 resection was achieved in all 245 patients, a median of 17 lymph nodes were resected, and the average length of stay was 3.1 days (range, 1 to 21 days). Major morbidity occurred in 3 patients, and there were no 30- or 90-day mortalities.

Conclusions: Robotic segmentectomy is safe, with excellent early clinical outcomes. In this series, electromagnetic navigational bronchoscopy and indocyanine green localization were efficient and effective at identifying the target lesion. Intravenous indocyanine green delineated the intersegmental plane.