Nationwide expert consensus on the clinical application and evaluation of 4K fluorescence high-end medical endoscopes in thoracic surgery (2023)_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 Thoracic Surgery Branch of China International Exchange and Promotive Association for Medical and Health Care , The Pulmonary Tumor Integration and Rehabilitation Professional Committee of the China Anti-Cancer Association , Thoracic Surgeon Branch of Zhejiang Medical Doctors Association

1. Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Clinical Evaluation Technology for Medical Device of Zhejiang Province, Hangzhou, 310003, P. R. China;

Corresponding author：

Thoracic Surgery Branch of China International Exchange and Promotive Association for Medical and Health Care, Email: dr_hujian@zju.edu.cn

Keywords：

4K fluorescence; medical endoscope; thoracic surgery; clinical application evaluation; expert consensus

DOI：

10.7507/1007-4848.202311071

Video：

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This consensus aims to introduce the applications of 4K high-definition technology and fluorescence technology in thoracic surgery, summarize and categorize the technical support for pulmonary segment surgery, and innovatively propose technical support for precise sleeve resection of pulmonary segments. It provides a reference for clinical use, points out the direction for the research and innovation of domestically produced high-end endoscopes, promotes the widespread application of excellent domestically produced medical endoscopes, and facilitates the development of domestically produced medical equipment.

Citation： Thoracic Surgery Branch of China International Exchange and Promotive Association for Medical and Health Care, The Pulmonary Tumor Integration and Rehabilitation Professional Committee of the China Anti-Cancer Association, Thoracic Surgeon Branch of Zhejiang Medical Doctors Association. Nationwide expert consensus on the clinical application and evaluation of 4K fluorescence high-end medical endoscopes in thoracic surgery (2023). Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(3): 337-342. doi: 10.7507/1007-4848.202311071 Copy

1.	高树庚, 胡坚, 张兰军, 等. 医用内窥镜临床评价体系专家共识. 中国肺癌杂志, 2020, 23(6): 409-413.
2.	Rassweiler JJ, Teber D. Advances in laparoscopic surgery in urology. Nat Rev Urol, 2016, 13(7): 387-399.
3.	Wang C, Cai L, Chen Q, et al. No-waiting segmentectomy: An optimized approach for segmentectomy. J Thorac Dis, 2021, 13(2): 784-788.
4.	Liang M, Wang L, Gao J, et al. An optimal thoracoscopic segmentectomy approach: Combined ultra-high-definition 4K endovision systems with "no-waiting" technique in S8-9 complex segmentectomy. Thorac Cancer, 2023, 14(12): 1098-1101.
5.	Chen T, Zhao W, Ji C, et al. Minimally invasive sleeve lobectomy for centrally located lung cancer: A real-world study with propensity-score matching. Front Oncol, 2023, 13: 1099514.
6.	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.
7.	Guigard S, Triponez F, Bédat B, et al. Usefulness of near-infrared angiography for identifying the intersegmental plane and vascular supply during video-assisted thoracoscopic segmentectomy. Interact Cardiovasc Thorac Surg, 2017, 25(5): 703-709.
8.	Anayama T, Hirohashi K, Miyazaki R, et al. Near-infrared dye marking for thoracoscopic resection of small-sized pulmonary nodules: Comparison of percutaneous and bronchoscopic injection techniques. J Cardiothorac Surg, 2018, 13(1): 5.
9.	Abbas A, Kadakia S, Ambur V, et al. Intraoperative electromagnetic navigational bronchoscopic localization of small, deep, or subsolid pulmonary nodules. J Thorac Cardiovasc Surg, 2017, 153(6): 1581-1590.
10.	Yamashita S, Tokuishi K, Anami K, et al. Video-assisted thoracoscopic indocyanine green fluorescence imaging system shows sentinel lymph nodes in non-small-cell lung cancer. J Thorac Cardiovasc Surg, 2011, 141(1): 141-144.
11.	Gotoh M, Yamamoto Y, Igai H, et al. Clinical application of infrared thoracoscopy to detect bullous or emphysematous lesions of the lung. J Thorac Cardiovasc Surg, 2007, 134(6): 1498-1501.
12.	Li H, Zhou J, Chi C, et al. Clinical application of near-infrared thoracoscope with indocyanine green in video-assisted thoracoscopic bullectomy. J Thorac Dis, 2016, 8(7): 1841-1845.
13.	中国医药教育协会胸外科专业委员会, 中国胸外科肺癌联盟, 浙江省医学会胸外科学分会, 等. 人工智能平台下肺结节的三维可视化定位与手术规划专家共识. 中国胸心血管外科临床杂志, 2019, 26(12): 1161-1166.
14.	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.
15.	望云, 樊荣荣, 施晓雷, 等. 胸部CT增强扫描结合三维可视化重建技术在靶肺叶和肺段解剖结构显示中的应用价值. 中华实用诊断与治疗杂志, 2019, 33(11): 1110-1113.
16.	Wang J, Xu XF, Wen W, et al. Modified method for distinguishing the intersegmental border for lung segmentectomy. Thorac Cancer, 2018, 9(2): 330-333.
17.	孙伟杰, 张敏, 陈旭, 等. 肺循环单向阻断段间平面识别法在肺段切除术中的应用. 中国胸心血管外科临床杂志, 2023, 30(1): 52-57.
18.	Misaki N, Chang SS, Gotoh M, et al. A novel method for determining adjacent lung segments with infrared thoracoscopy. J Thorac Cardiovasc Surg, 2009, 138(3): 613-618.
19.	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.
20.	Matsuoka H, Nishio W, Sakamoto T, et al. Selective segmental jet injection to distinguish the intersegmental plane using jet ventilation. Jpn J Thorac Cardiovasc Surg, 2003, 51(8): 400-401.
21.	Yasuo Sekine A, Eitetsu Ko A, Hideto Oishi B, et al. A simple and effective technique for identification of intersegmental planes by infrared thoracoscopy after transbronchial injection of indocyanine green. J Thorac Cardiovasc Surg, 2012, 143(6): 1330-1335.
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.	Zhang Z, Liao Y, Ai B, et al. Methylene blue staining: A new technique for identifying intersegmental planes in anatomic segmentectomy. Ann Thorac Surg, 2015, 99(1): 238-242.
24.	Sakamoto K, Kanzaki M, Mitsuboshi S, et al. A novel and simple method for identifying the lung intersegmental plane using thermography. Interact Cardiovasc Thorac Surg, 2016, 23(1): 171-173.
25.	陈醒狮, 金润森. 肺段切除术中段间平面处理方式的研究进展. 中国微创外科杂志, 2019, 19(2): 190-192.
26.	陈昊, 黄麟, 郑斌, 等. 单孔胸腔镜下肺段切除术中超声刀分离段间平面的应用研究. 中华胸部外科电子杂志, 2019, 6(2): 131-135.
27.	Keisuke A, Yotaro I, Mitsutomo K, et al. Effect of cutting technique at the intersegmental plane during segmentectomy on expansion of the preserved segment: Comparison between staplers and scissors in ex vivo pig lung. Eur J Cardiothorac Surg, 2011, 40(1): e34-e38.
28.	Yoshimoto K, Nomori H, Mori T, et al. Comparison of postoperative pulmonary function and air leakage between pleural closure vs. mesh-cover for intersegmental plane in segmentectomy. J Cardiothorac Surg, 2011, 6: 61.
29.	Ohtsuka T, Goto T, Anraku M, et al. Dissection of lung parenchyma using electrocautery is a safe and acceptable method for anatomical sublobar resection. J Cardiothorac Surg, 2012, 7: 42.
30.	Wang J, Xu X, Wen W, et al. Technique for tailoring complex demarcation in lung segmentectomy. Thorac Cancer, 2018, 9(11): 1562-1564.
31.	吴卫兵, 朱全, 闻伟, 等. 应用改良膨胀萎陷法行胸腔镜锥式肺段切除术146例. 中华胸心血管外科杂志, 2017, 33(9): 517-521.
32.	Okada M, Nishio W, Sakamoto T, et al. Sleeve segmentectomy for non-small cell lung carcinoma. J Thorac Cardiovasc Surg, 2004, 128(3): 420-424.
33.	Qu R, Ping W, Hao Z, et al. Surgical outcomes of segmental bronchial sleeve resection in central non-small cell lung cancer. Thorac Cancer, 2020, 11(5): 1319-1325.
34.	Li N, Tan F, Chen W, et al. One-off low-dose CT for lung cancer screening in China: A multicentre, population-based, prospective cohort study. Lancet Respir Med, 2022, 10(4): 378-391.
35.	National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
36.	FordePM, Spicer J, Lu S, et al. Neoadjuvant nivolumab plus chemotherapy in esectable lung cancer. N Engl J Med, 2022, 2386(21): 1973-1985.
37.	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.
38.	Suzuki K, Watanabe SI, Wakabayashi M, et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg, 2022, 163(1): 289-301. e2.

1. 高树庚, 胡坚, 张兰军, 等. 医用内窥镜临床评价体系专家共识. 中国肺癌杂志, 2020, 23(6): 409-413.
2. Rassweiler JJ, Teber D. Advances in laparoscopic surgery in urology. Nat Rev Urol, 2016, 13(7): 387-399.
3. Wang C, Cai L, Chen Q, et al. No-waiting segmentectomy: An optimized approach for segmentectomy. J Thorac Dis, 2021, 13(2): 784-788.
4. Liang M, Wang L, Gao J, et al. An optimal thoracoscopic segmentectomy approach: Combined ultra-high-definition 4K endovision systems with "no-waiting" technique in S8-9 complex segmentectomy. Thorac Cancer, 2023, 14(12): 1098-1101.
5. Chen T, Zhao W, Ji C, et al. Minimally invasive sleeve lobectomy for centrally located lung cancer: A real-world study with propensity-score matching. Front Oncol, 2023, 13: 1099514.
6. 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.
7. Guigard S, Triponez F, Bédat B, et al. Usefulness of near-infrared angiography for identifying the intersegmental plane and vascular supply during video-assisted thoracoscopic segmentectomy. Interact Cardiovasc Thorac Surg, 2017, 25(5): 703-709.
8. Anayama T, Hirohashi K, Miyazaki R, et al. Near-infrared dye marking for thoracoscopic resection of small-sized pulmonary nodules: Comparison of percutaneous and bronchoscopic injection techniques. J Cardiothorac Surg, 2018, 13(1): 5.
9. Abbas A, Kadakia S, Ambur V, et al. Intraoperative electromagnetic navigational bronchoscopic localization of small, deep, or subsolid pulmonary nodules. J Thorac Cardiovasc Surg, 2017, 153(6): 1581-1590.
10. Yamashita S, Tokuishi K, Anami K, et al. Video-assisted thoracoscopic indocyanine green fluorescence imaging system shows sentinel lymph nodes in non-small-cell lung cancer. J Thorac Cardiovasc Surg, 2011, 141(1): 141-144.
11. Gotoh M, Yamamoto Y, Igai H, et al. Clinical application of infrared thoracoscopy to detect bullous or emphysematous lesions of the lung. J Thorac Cardiovasc Surg, 2007, 134(6): 1498-1501.
12. Li H, Zhou J, Chi C, et al. Clinical application of near-infrared thoracoscope with indocyanine green in video-assisted thoracoscopic bullectomy. J Thorac Dis, 2016, 8(7): 1841-1845.
13. 中国医药教育协会胸外科专业委员会, 中国胸外科肺癌联盟, 浙江省医学会胸外科学分会, 等. 人工智能平台下肺结节的三维可视化定位与手术规划专家共识. 中国胸心血管外科临床杂志, 2019, 26(12): 1161-1166.
14. 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.
15. 望云, 樊荣荣, 施晓雷, 等. 胸部CT增强扫描结合三维可视化重建技术在靶肺叶和肺段解剖结构显示中的应用价值. 中华实用诊断与治疗杂志, 2019, 33(11): 1110-1113.
16. Wang J, Xu XF, Wen W, et al. Modified method for distinguishing the intersegmental border for lung segmentectomy. Thorac Cancer, 2018, 9(2): 330-333.
17. 孙伟杰, 张敏, 陈旭, 等. 肺循环单向阻断段间平面识别法在肺段切除术中的应用. 中国胸心血管外科临床杂志, 2023, 30(1): 52-57.
18. Misaki N, Chang SS, Gotoh M, et al. A novel method for determining adjacent lung segments with infrared thoracoscopy. J Thorac Cardiovasc Surg, 2009, 138(3): 613-618.
19. 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.
20. Matsuoka H, Nishio W, Sakamoto T, et al. Selective segmental jet injection to distinguish the intersegmental plane using jet ventilation. Jpn J Thorac Cardiovasc Surg, 2003, 51(8): 400-401.
21. Yasuo Sekine A, Eitetsu Ko A, Hideto Oishi B, et al. A simple and effective technique for identification of intersegmental planes by infrared thoracoscopy after transbronchial injection of indocyanine green. J Thorac Cardiovasc Surg, 2012, 143(6): 1330-1335.
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. Zhang Z, Liao Y, Ai B, et al. Methylene blue staining: A new technique for identifying intersegmental planes in anatomic segmentectomy. Ann Thorac Surg, 2015, 99(1): 238-242.
24. Sakamoto K, Kanzaki M, Mitsuboshi S, et al. A novel and simple method for identifying the lung intersegmental plane using thermography. Interact Cardiovasc Thorac Surg, 2016, 23(1): 171-173.
25. 陈醒狮, 金润森. 肺段切除术中段间平面处理方式的研究进展. 中国微创外科杂志, 2019, 19(2): 190-192.
26. 陈昊, 黄麟, 郑斌, 等. 单孔胸腔镜下肺段切除术中超声刀分离段间平面的应用研究. 中华胸部外科电子杂志, 2019, 6(2): 131-135.
27. Keisuke A, Yotaro I, Mitsutomo K, et al. Effect of cutting technique at the intersegmental plane during segmentectomy on expansion of the preserved segment: Comparison between staplers and scissors in ex vivo pig lung. Eur J Cardiothorac Surg, 2011, 40(1): e34-e38.
28. Yoshimoto K, Nomori H, Mori T, et al. Comparison of postoperative pulmonary function and air leakage between pleural closure vs. mesh-cover for intersegmental plane in segmentectomy. J Cardiothorac Surg, 2011, 6: 61.
29. Ohtsuka T, Goto T, Anraku M, et al. Dissection of lung parenchyma using electrocautery is a safe and acceptable method for anatomical sublobar resection. J Cardiothorac Surg, 2012, 7: 42.
30. Wang J, Xu X, Wen W, et al. Technique for tailoring complex demarcation in lung segmentectomy. Thorac Cancer, 2018, 9(11): 1562-1564.
31. 吴卫兵, 朱全, 闻伟, 等. 应用改良膨胀萎陷法行胸腔镜锥式肺段切除术146例. 中华胸心血管外科杂志, 2017, 33(9): 517-521.
32. Okada M, Nishio W, Sakamoto T, et al. Sleeve segmentectomy for non-small cell lung carcinoma. J Thorac Cardiovasc Surg, 2004, 128(3): 420-424.
33. Qu R, Ping W, Hao Z, et al. Surgical outcomes of segmental bronchial sleeve resection in central non-small cell lung cancer. Thorac Cancer, 2020, 11(5): 1319-1325.
34. Li N, Tan F, Chen W, et al. One-off low-dose CT for lung cancer screening in China: A multicentre, population-based, prospective cohort study. Lancet Respir Med, 2022, 10(4): 378-391.
35. National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
36. FordePM, Spicer J, Lu S, et al. Neoadjuvant nivolumab plus chemotherapy in esectable lung cancer. N Engl J Med, 2022, 2386(21): 1973-1985.
37. 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.
38. Suzuki K, Watanabe SI, Wakabayashi M, et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg, 2022, 163(1): 289-301. e2.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Nationwide expert consensus on the clinical application and evaluation of 4K fluorescence high-end medical endoscopes in thoracic surgery (2023)

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