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

BACKGROUND

We investigated the feasibility and efficacy of thoracoscopic segmentectomy using 3-dimensional computed tomography( 3D-CT) and indocyanine-green( ICG) fluorescence navigation.

METHODS

ICG fluorescence-navigated thoracoscopic segmentectomy was performed in 149 patients during 2013 and 2017. Each patient underwent preoperative evaluation by thin-section enhanced CT, which provided 3-dimensional simulations of vascular and bronchial structures. During the procedure, low-dose ICG( 0.15~0.25 mg/kg) was injected systemically after the target segmental pulmonary arteries and bronchus were divided. Under near-infrared thoracoscopic guidance, an intersegmental plane was clearly observed as a border between dark target region and bright residual region. The ICG fluorescent line was marked by electrocautery, followed by division of lung parenchyma along the line by endoscopic staples.

RESULTS

An intersegmental line was visible in 98% of patients by ICG fluorescence navigation. No ICG-related adverse events occurred. No operative mortality was observed and morbidity rate was 8.7%. The 5-year overall survival rate and the 5-year recurrence free probability of 101 patients with primary lung cancer were 92% and 98%, respectively. Local recurrence at the resected site occurred in no patient with lung cancer and 1 patient with pulmonary metastasis.

CONCLUSION

Thoracoscopic segmentectomy using 3D-CT and ICG fluorescence navigation is a useful therapeutic option.