Influencing Factors on Intersegmental Identification Adequacy in Segmentectomy with Intraoperative Indocyanine Green (ICG) Intravenous Administration
by
, ,
Harushi Ueno
*, 
Tomohiro Setogawa
,
Ayaka Makita
,
Yuko Ohara
,
Yoshito Imamura
,
Shoji Okado
,
Hiroki Watanabe
,
Yuta Kawasumi
,
Yuka Kadomatsu
,
Taketo Kato
,
Shota Nakamura
,
Tetsuya Mizuno
and
Toyofumi Fengshi Chen-Yoshikawa
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan
*
Author to whom correspondence should be addressed.
Cancers 2023, 15(24), 5876; https://doi.org/10.3390/cancers15245876
Submission received: 14 November 2023
/
Revised: 9 December 2023
/
Accepted: 13 December 2023
/
Published: 17 December 2023
(This article belongs to the Special Issue Beyond the Standard: A Paradigm Shift with Precision Lung Cancer Surgery)
Simple Summary
Segmentectomy, a surgical technique aimed at preserving as much lung tissue as possible, has become increasingly common for many small lung cancers. Since the boundaries of lung regions cannot be directly identified, various methods are employed to visualize them. The method involves using Indocyanine Green (ICG). During surgery, the vessels supplying the area to be removed are dissected, followed by the intravascular administration of ICG. When viewed with a near-infrared camera, the remaining lung fluoresces, enabling clear visualization of region boundaries. This technique is both convenient and safe. Despite following the correct procedure, there may still be instances where the region boundaries are not clearly delineated. In such instances, it is crucial to anticipate the need for alternative methods to define regional boundaries in advance. In this study, we conducted retrospective research to ascertain the causes of the unclear boundaries.
Abstract
Accurate identification of the intersegmental plane is essential in segmentectomy, and Indocyanine Green (ICG) assists in visualizing lung segments. Various factors, including patient-related, intraoperative, and technical issues, can influence boundary delineation. This study aims to assess the rate of unsuccessful intersegmental identification and identify the contributing factors. We analyzed cases of lung segmentectomy from April 2020 to March 2023, where intraoperative ICG was intravenously administered during robot-assisted or video-assisted thoracoscopic surgery. Cases where fluorescence extended beyond expected boundaries within 30 s were classified as the “unclear boundary group”. This group was then compared to the “clear boundary group”. The study encompassed 111 cases, 104 (94%) of which were classified under the “clear boundary group” and 7 (6%) under the “unclear boundary group”. The “unclear boundary group” had a significantly lower DLCO (15.7 vs. 11.8, p = 0.03) and DLCO/VA (4.3 vs. 3.0, p = 0.01) compared to the “clear boundary group”. All cases in the “unclear boundary group” underwent lower lobe segmentectomy. ICG administration effectively outlines pulmonary segments. Challenges in segment demarcation may occur in cases with low DLCO and DLCO/VA values, particularly during lower lobe segmentectomy.
