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;
SHAO Feng, Email: doctorshao1982@sina.com
Segmentectomy; pulmonary vein; fluorescence; indocyanine green; pulmonary circulation
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.