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[Thoracoscopic Segmentectomy Using Three-dimensional Computed Tomography and Indocyanine-green Fluorescence

Junji Ichinose1, Yosuke Matsuura, Masayuki Nakao

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Kyobu Geka. the Japanese Journal of Thoracic Surgery
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Thoracoscopic segmentectomy using 3D-CT and indocyanine-green (ICG) fluorescence navigation is feasible and effective. This technique accurately identifies intersegmental planes, leading to excellent survival rates for lung cancer patients.

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Area of Science:

  • Thoracic Surgery
  • Surgical Navigation
  • Pulmonary Medicine

Background:

  • Investigating the feasibility and efficacy of thoracoscopic segmentectomy.
  • Utilizing 3-dimensional computed tomography (3D-CT) and indocyanine-green (ICG) fluorescence navigation.

Purpose of the Study:

  • To evaluate the safety and effectiveness of ICG fluorescence-navigated thoracoscopic segmentectomy.
  • To assess the visualization of intersegmental planes and patient outcomes.

Main Methods:

  • Performed ICG fluorescence-navigated thoracoscopic segmentectomy in 149 patients (2013-2017).
  • Used 3D-CT for preoperative simulation of vascular and bronchial structures.
  • Administered low-dose ICG and observed fluorescence under near-infrared thoracoscopic guidance to identify intersegmental planes.

Main Results:

  • Achieved 98% visibility of intersegmental lines using ICG fluorescence navigation.
  • Reported no ICG-related adverse events, operative mortality, and an 8.7% morbidity rate.
  • Observed 5-year overall survival of 92% and recurrence-free probability of 98% in 101 primary lung cancer patients.

Conclusions:

  • Thoracoscopic segmentectomy with 3D-CT and ICG fluorescence navigation is a viable therapeutic option.
  • Demonstrated high efficacy and safety in identifying surgical margins and improving patient outcomes.