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Updated: May 26, 2026
Robotic-assisted Bronchoscopy Combined with Multimodal Imaging for Targeted Lung Cryobiopsies
Published on: July 19, 2024
Retrospective comparison of three-dimensional computed tomography bronchography and angiography-assisted indocyanine
Chen Liu1, Hao Peng1, Maitiyasen Maierhaba1
1Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Background:
Over the long term, the modified inflation-deflation method has been widely recognized as a strategy for identifying the intersegmental plane. However, with the advancement of technology, an increasing number of methods for intersegmental plane identification have emerged, such as the intravenous indocyanine green (ICG) injection method, which can display the intersegmental plane more accurately. This study aims to provide a single-center retrospective comparative evaluation of the safety, feasibility, and perioperative outcomes of intravenous ICG reverse staining versus the modified inflation-deflation method for intersegmental plane delineation in robotic-assisted thoracoscopic surgery (RATS) segmentectomy.
Methods:
We collected data from 117 consecutive patients who underwent RATS segmentectomy at Jinling Hospital Affiliated to Nanjing University between September 2022 and November 2024, all of whom received preoperative three-dimensional computed tomography bronchography and angiography (3D-CTBA) reconstruction for surgical planning, including 57 patients in the ICG group and 60 patients in the modified inflation-deflation group. A retrospective analysis was conducted on surgery-related indicators such as operation time, intersegmental boundary demonstration time, and intraoperative blood loss, as well as the incidence of postoperative complications, between the two groups.
Results:
All patients successfully completed the surgery. The operation time of the ICG group (112.11±26.12 min) was significantly shorter than that of the modified inflation-deflation group (129.37±34.35 min) [t=-3.07; P=0.003; Cohen's d=-0.56; 95% confidence interval (CI): -28.48, -6.04]. The intersegmental boundary display time of the ICG group (9.44±2.19 s) was remarkably shorter than that of the modified inflation-deflation group (1,068.08±229.40 s), with statistically significant differences (t=-35.74; P<0.001; Cohen's d=-6.44; 95% CI: -1,118.85, -998.44). Additionally, the intraoperative blood loss of the ICG group (73.07±39.37 mL) was significantly less than that of the modified inflation-deflation group (113.00±59.75 mL), and the difference was statistically significant (t=-4.24; P<0.001; Cohen's d=-0.79; 95% CI: -58.40, -21.46).
Conclusions:
In RATS segmental lung resection with preoperative 3D-CTBA reconstruction, the ICG reverse staining method for intersegmental plane delineation is associated with shorter intersegmental boundary display time, clearer boundaries, less intraoperative blood loss, and shorter operation time compared with the modified inflation-deflation method. These findings provide comparative evidence to support clinical decision-making, while long-term oncological outcomes require further validation.
