title: A simple and effective technique for identification of intersegmental planes by infrared thoracoscopy after transbronchial injection of indocyanine green.
abstract: OBJECTIVE
  Pulmonary segmentectomy has been recognized as an operative option for complete resection of early-stage lung cancer in patients with poor pulmonary function. However, identification of anatomic pulmonary segments is sometimes difficult in patients with emphysema. We developed an intraoperative method for identifying intersegmental planes of the lung with high-sensitivity infrared fluorescence imaging after transbronchial injection of indocyanine green.
  
  
  METHODS
  The study included 10 patients with early-stage lung cancer who underwent thoracoscopic segmentectomy. Under general anesthesia, indocyanine green was injected into the bronchus of target pulmonary segments. The target segments of the lung were identified using the indocyanine green fluorescence endoscope (Hamamatsu Photonics, Hamamatsu, Japan). The intersegmental lines and planes were identified and allowed removal of the segments. To evaluate operative outcomes, we compared the indocyanine green injection group with a retrospective control group with 10 matched-pair patients who underwent traditional thoracoscopic segmentectomy.
  
  
  RESULTS
  Accurate, real-time intraoperative detection of indocyanine green with an infrared thoracoscope was confirmed. Sparing of intersegments was safely performed using both staples and electric cautery. Furthermore, infrared thoracoscopy allowed visualization of any residual portion of resected segments after segmentectomy. There was no difference between the experimental indocyanine green and control groups in terms of operative time, duration of postoperative chest drainage, or postoperative complications. Length of stay was shorter in the indocyanine green group than in the control group (P = .055).
  
  
  CONCLUSIONS
  Transbronchial indocyanine green injection into the relevant bronchus with the use of an infrared thoracoscope allows identification of intersegmental lines and planes during thoracoscopic segmentectomy.
authors.affiliation: Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan. ysekine@tymc.twmu.ac.jp
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sekine
authors.forename: Eitetsu
authors.initials: E
authors.lastname: Ko
authors.forename: Hideto
authors.initials: H
authors.lastname: Oishi
authors.forename: Mitsuharu
authors.initials: M
authors.lastname: Miwa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004867:Equipment Design; D005260:Female; D005453:Fluorescence; D005456:Fluorescent Dyes / Q000008:administration & dosage; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage; D007259:Infrared Rays; D007430:Intraoperative Care; D007564:Japan; D007902:Length of Stay; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020708:Thoracoscopes; D013906:Thoracoscopy / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green