title: A new fluorescent anatomic pulmonary segmentectomy using PDD endoscope system and vitamin B2: evaluation in a clinical setting using living animal.
abstract: OBJECTIVE
  Identification of intersegmental planes is essential for successful anatomic pulmonary segmentectomy. We have previously reported a new fluorescence technique using a PDD endoscope system™ and vitamin B2 for identification of intersegmental planes in ex vivo experiments. In the present study, we investigated and evolved this technique to perform ideal anatomic segmentectomy in a clinical setting using living pig models.
  
  
  METHODS
  Cranial segmentectomy in the cranial lobe of the right lung was performed in six pigs using our fluorescence technique. The fluorescent cranial segmentectomy was as follows. After identification of the cranial segmental bronchus, vitamin B2 solution as a fluorescent substance was injected via bronchoscopy. The fluorescent segment was observed using a PDD endoscope system, and the identified intersegmental plane was cut using electric cautery. The operative data collected were the rates of accurate identification of the pulmonary segment and perioperative complications. The duration and light intensity of fluorescence of the target segment were recorded to provide an objective measurement of success.
  
  
  RESULTS
  In all procedures, it was possible to identify the target segment by its clear yellow-green fluorescence. The rate of accurate identification of the pulmonary segment was 100%. The fluorescence continued for more than 1 h with adequate light intensity. No perioperative complications were encountered. No unexpected injuries of the major segmental bronchi or vessels occurred. Hemorrhage and air leakage from the transected intersegmental plane were negligible.
  
  
  CONCLUSIONS
  Our new fluorescence technique in a clinical setting involving a PDD endoscope system™ vitamin B2 enabled accurate and safe anatomic pulmonary segmentectomy, with enough strong and long fluorescence in living pig lungs.
authors.affiliation: Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University, Kanazawa, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ohsima
authors.affiliation: Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University, Kanazawa, Japan. wryuichi@hotmail.com.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Waseda
authors.affiliation: Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University, Kanazawa, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tanaka
authors.affiliation: Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University, Kanazawa, Japan.
authors.forename: Hideyasu
authors.initials: H
authors.lastname: Ueda
authors.affiliation: Department of Human Pathology, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, Japan.
authors.forename: Akishi
authors.initials: A
authors.lastname: Ooi
authors.affiliation: Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University, Kanazawa, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Matsumoto
mesh_terms: D000818:Animals; D002425:Cautery; D019723:Endoscopes; D005453:Fluorescence; D023421:Models, Animal; D017319:Photosensitizing Agents; D011013:Pneumonectomy / Q000379:methods*; D012256:Riboflavin; D013552:Swine
chemical_list: D017319:Photosensitizing Agents; D012256:Riboflavin
keywords: Photodynamic theory; Pulmonary (lungs); Surgical < technical; Thoracoscopy