Dual Image Navigation to Secure Surgical Margins in Thoracoscopic Segmentectomy

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Medical Imaging

Background:

• Video-assisted thoracoscopic surgery (VATS) segmentectomy is increasingly utilized for non-small cell lung cancer.
• Accurate identification of surgical margins is challenging for non-palpable lung lesions during VATS segmentectomy.

Purpose of the Study:

• To evaluate the efficacy of intraoperative dual image navigation, combining IRT-ICG and intraoperative CT, for oncological margin assessment.
• To determine the role of this combined navigation technique in facilitating precise segmentectomy for non-palpable lung tumors.

Main Methods:

• A prospective study of 34 patients undergoing IRT-ICG and intraoperative CT-assisted thoracoscopic segmentectomy.
• Visualization of intersegmental lines using IRT-ICG, followed by intraoperative CT for anatomical confirmation and margin assessment.
• Surgeons utilized intraoperative CT or 3D reconstructions to guide resection and ensure adequate margins.

Main Results:

• A clearly defined intersegmental line was visualized in 91.2% of patients using the IRT-ICG method.
• Sufficient surgical margins were achieved in all cases, with modifications made in 8 instances.
• The mean surgical margin was 23.4 ± 9.0 mm, and complete tumor resection was confirmed.

Conclusions:

• Intraoperative dual image navigation with IRT-ICG and CT scanning is effective for VATS segmentectomy.
• This combined approach enables precise identification of oncological margins for non-palpable lung lesions.
• Definitive VATS segmentectomy with adequate margins is achievable using this navigation strategy.