Feasibility investigation of near‐infrared fluorescence imaging with intravenous indocyanine green method in uniport video‐assisted thoracoscopic anatomical segmentectomy for identifying the intersegmental boundary line

Abstract

Objectives

To investigate the perioperative outcomes of patients who underwent uniport video‐assisted thoracoscopic (VATS) segmentectomy for identifying the intersegmental boundary line (IBL) by the near‐infrared fluorescence imaging with the intravenous indocyanine green (ICG) method or the modified inflation‐deflation (MID) method and assess the feasibility and effectiveness of the ICG fluorescence (ICGF)‐based method.

Methods

We retrospectively analyzed the perioperative data in total 198 consecutive patients who underwent uniport VATS segmentectomy between February 2018 and August 2020. With the guidance of a preoperative imaging interpretation and analysis system (IQQA‐3D), the targeted segment structures could be precisely identified and dissected, and then the IBL was confirmed by the ICGF‐based method or the MID method. The clinical effectiveness and postoperative complications of the two methods were evaluated.

Results

An IBL was visible in 98% of patients in the ICGF‐based group, even with low doses of ICG. The ICGF‐based group was significantly associated with a shorter IBL clear presentation time (23.6 ± 4.4 vs. 23.6 ± 4.4 s) ( p < 0.01) and operative time (89.3 ± 31.6 vs. 112.9 ± 33.3 min) ( p < 0.01) compared to the MID group. The incidence of postoperative prolonged air leaks was higher in the MID group than in the ICGF‐based group (8/100, 8% vs. 26/98, 26.5%, p = 0.025). There were no significant differences in bleeding volume, chest tube duration, postoperative hospital stays, surgical margin width, and other postoperative complications.

Conclusion

The ICGF‐based method could highly accurately identify the IBL and make anatomical segmentectomy easier and faster, and therefore has the potential to be a feasible and effective technique to facilitate the quality of uniport VATS segmentectomy.

Abstract

Based on a large amount of clinical data, we found that the identification rate of IBL via ICGF‐based method is comparable to the traditional MID method which is the globally accepted. Our study shows that the ICGF‐based method can highly accurately identify the IBL and make anatomical segmentectomy easier and faster, and it helps to ensure sufficient resection margins, and therefore has the potential to be a feasible and effective technique to facilitate the quality of uniport VATS segmentectomy.