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Complete visualization using indocyanine green in thoracic surgery for pulmonary sequestration.

Keita Nakanishi1, Yuka Kadomatsu1, Harushi Ueno1

  • 1Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Journal of Thoracic Disease
|November 16, 2023
PubMed
Summary

Preoperative 3D CT and intraoperative indocyanine green (ICG) fluorescence imaging improve thoracic surgery for pulmonary sequestration (PS). This technique safely identifies aberrant arteries and delineates lung boundaries for minimally invasive resection.

Keywords:
Pulmonary sequestration (PS)indocyanine green (ICG)surgerythree-dimensional computed tomography (three-dimensional CT)visualization

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Area of Science:

  • Thoracic Surgery
  • Medical Imaging
  • Pulmonary Medicine

Background:

  • Pulmonary sequestration (PS) surgery requires precise identification of aberrant arteries and lung boundaries.
  • Minimally invasive approaches are preferred for improved patient outcomes.

Purpose of the Study:

  • To evaluate the efficacy of preoperative 3D CT and intraoperative indocyanine green (ICG) fluorescence imaging in pulmonary sequestration surgery.
  • To assess the safety and feasibility of minimally invasive resection using these techniques.

Main Methods:

  • Retrospective review of 17 patients undergoing intralobar PS resection (2009-2022).
  • Utilized preoperative 3D CT for aberrant artery identification.
  • Employed intraoperative near-infrared fluorescence imaging with ICG since 2019 to visualize the normal-sequestrated lung boundary.

Main Results:

  • Preoperative 3D CT accurately identified aberrant arteries in all cases.
  • ICG fluorescence clearly delineated the lung boundary in all six patients who received it.
  • Median operative time was 145 minutes, median blood loss was 5 mL, and median hospital stay was 5 days.
  • Near-infrared thoracoscopy with overlay mode enhanced safety and boundary delineation compared to conventional methods.

Conclusions:

  • Preoperative 3D CT and intraoperative ICG imaging are effective for safe and minimally invasive pulmonary sequestration surgery.
  • ICG facilitates precise lesion resection while preserving normal lung tissue.
  • This combined imaging approach offers a feasible and safe method for intralobar PS treatment.