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. 2022 Jul 9;35(2):ivac064.
doi: 10.1093/icvts/ivac064.

Novel thoracoscopic segmentectomy combining preoperative three-dimensional image simulation and intravenous administration of indocyanine green

Natsumi Matsuura  1 , Hitoshi Igai  1 , Fumi Ohsawa  1 , Kazuki Numajiri  1 , Mitsuhiro Kamiyoshihara  1
Affiliations

Novel thoracoscopic segmentectomy combining preoperative three-dimensional image simulation and intravenous administration of indocyanine green

Natsumi Matsuura et al. Interact Cardiovasc Thorac Surg. .

Abstract

Objectives: The aim of this study is to assess prospectively the validity and feasibility of segmentectomy using preoperative simulation and intravenous indocyanine green (ICG) with near-infrared (NIR) light thoracoscope to ensure a sufficient surgical margin.

Methods: This study was a prospective, single-centre, phase II, feasibility study. From February to July 2021, 20 patients were enrolled in this study. All patients underwent preoperative three-dimensional computed tomography angiography and bronchography using simulation software. The dominant pulmonary artery of the targeted segment was selected to determine the dissection line and measure the surgical margin to the tumour. Intraoperatively, after the planned dissection of the pulmonary artery, ICG (0.3 mg/kg) was administered intravenously and observed with NIR, and dissection was performed along the line determined by preoperative simulation. Postoperatively, the pathological margin was compared with the simulation margin.

Results: All surgeries were performed via an uniport (3.5-4.0-cm skin incision). The regions of segmentectomy were S2, S3, S6, S9 + 10 and S10 of the right side and S1 + 2 + 3, S3, S3 + 4 + 5, S6 and S8 of the left side. The difference between the simulation margin and the pathological margin was not significant (simulation 30.5 ± 10.1 vs pathological 31.0 ± 11.0 mm, P = 0.801). The simulation margin was well correlated with the pathological margin (R2 = 0.677). The proportion of cases successfully achieving the pathological margin of error of plus or minus 10 mm of the simulation margin was 90% (18 of 20 cases).

Conclusions: The combination of preoperative three-dimensional computed tomography simulation and ICG-NIR was effective for securing a sufficient margin in segmentectomy.

Keywords: Indocyanine green; Segmentectomy; Surgical margin; Three-dimensional computed tomography.

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Figures

Figure 1:
Figure 1:
A case of a small-sized part-solid ground glass opacity located at right S3a (A). Three-dimensional computed tomography angiography showing the dominant pulmonary arteries (A3a and A3b) and the location of the tumour (B). Based on the perfusion area of A3a and A3b, simulation of right S3 segmentectomy shows that the margin from the intersegmental line to the tumour is 29.9 mm (C). Intraoperative indocyanine green image using a near-infrared light thoracoscope shows clear visualization as simulated (D). A resected lung specimen. The pathological margin in this case is 25 mm (E). CT: computed tomography.
Figure 2:
Figure 2:
The indocyanine green demarcation score. Clear visualization without interruption (3 points, excellent) (A). Partially unclear but generally identifiable (2 points, fair) (computed tomography). Difficult to identify (1 point, poor) (C).
Figure 3:
Figure 3:
The intersegmental demarcation score. The method to calculate the score is to divide the total score by the number of intersegmental planes (S2/3/8/9/9 + 10: 4, S6/S1 + 2 + 3/S3 + 4 + 5: 2). ICG: indocyanine green.
Figure 4:
Figure 4:
The relationship between the simulation margin and the pathological margin.
None
See this image and copyright information in PMC

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