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Saeki Y, Nakaoka K, Inagaki M. Identification of the Separation Range of an Incomplete Interlobar Fissure in Segmentectomy Using Near Infrared. Cureus 2023; 15:e38009. [PMID: 37228543 PMCID: PMC10207970 DOI: 10.7759/cureus.38009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/27/2023] Open
Abstract
In segmentectomy for patients with incomplete interlobar fissures, insufficient dissection of the interlobar parenchyma may result in incomplete segmentectomy, while excessive dissection may lead to excessive bleeding and air leaks. Here, we report a case of left apicoposterior (S1+2) segmentectomy with incomplete interlobar fissure in which near-infrared thoracoscopy with indocyanine green was used to identify the separation range of interlobar fissure by dissecting the relevant vessels beforehand.
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Affiliation(s)
- Yusuke Saeki
- Department of Thoracic Surgery, University of Tsukuba, Tsukuba, JPN
- Department of Thoracic Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, JPN
| | - Kojiro Nakaoka
- Department of Thoracic Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, JPN
| | - Masaharu Inagaki
- Department of Thoracic Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, JPN
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Ng CSH, Ong BH, Chao YK, Wright GM, Sekine Y, Wong I, Hao Z, Zhang G, Chaturvedi H, Thammineedi SR, Law S, Kim HK. Use of Indocyanine Green Fluorescence Imaging in Thoracic and Esophageal Surgery. Ann Thorac Surg 2023; 115:1068-1076. [PMID: 36030832 DOI: 10.1016/j.athoracsur.2022.06.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/19/2022] [Accepted: 06/25/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Fluorescence imaging using indocyanine green in thoracic and esophageal surgery is gaining popularity because of the potential to facilitate surgical planning, to stage disease, and to reduce postoperative complications. To optimize use of fluorescence imaging in thoracic and esophageal surgery, an expert panel sought to establish a set of recommendations at a consensus meeting. METHODS The panel included 12 experts in thoracic and upper gastrointestinal surgery from Asia-Pacific countries. Before meeting, 7 focus areas were defined: intersegmental plane identification for sublobar resections; pulmonary nodule localization; lung tumor detection; bullous lesion detection; lymphatic mapping of lung tumors; evaluation of gastric conduit perfusion; and lymphatic mapping in esophageal surgical procedures. A literature search of the PubMed database was conducted using keywords indocyanine green, fluorescence, thoracic, surgery, and esophagectomy. At the meeting, panelists addressed each focus area by discussing the most relevant evidence and their clinical experiences. Consensus statements were derived from the proceedings, followed by further discussions, revisions, finalization, and unanimous agreement. Each statement was assigned a level of evidence and a grade of recommendation. RESULTS A total of 9 consensus recommendations were established. Identification of the intersegmental plane for sublobar resections, localization of pulmonary nodules, lymphatic mapping in lung tumors, and assessment of gastric conduit perfusion were applications of fluorescence imaging that have the most robust current evidence. CONCLUSIONS Based on best available evidence and expert opinions, these consensus recommendations may facilitate thoracic and esophageal surgery using fluorescence imaging.
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Affiliation(s)
- Calvin Sze-Hang Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
| | - Boon-Hean Ong
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Yin Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan, Taiwan
| | - Gavin M Wright
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Yasuo Sekine
- Department of Thoracic Surgery, Yachiyo Medical Center, Tokyo Women's Medical University, Yachiyo, Japan
| | - Ian Wong
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | - Zhexue Hao
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guangjian Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | | | | | - Simon Law
- Department of Surgery, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University Guro Hospital, Seoul, Korea
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Use of a radiofrequency identification system for precise sublobar resection of small lung cancers. Surg Endosc 2023; 37:2388-2394. [PMID: 36401101 DOI: 10.1007/s00464-022-09768-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/06/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The incidence of sublobar resection is increasing because of the rise in the detection of small lung cancers. However, local recurrence needs to be addressed, and several methods are needed for the resection with secure margins of non-visible and non-palpable tumors. METHODS We retrospectively reviewed the use of a radiofrequency identification (RFID) system in sublobar resection of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) at our institute. RESULTS From June 2020 to June 2022, 39 patients underwent sublobar resection for AIS or MIA. The median age was 69 years (interquartile range, 64-76). Among the 39 patients, 24 were diagnosed with AIS and 15 with MIA. Segmentectomy, subsegmentectomy, and wedge resection were performed in nine, six, and 24 patients, respectively. The median size of the target tumor was 9.0 mm (8.1-12.9) and the median distance between the tag and the tumor was 2.9 mm (0-7.5). The median pathological surgical margin was 15.0 mm (10-17.5). Complete resection of all lesions was performed with a secure surgical margin. The median follow-up duration was 6 months, during which no local recurrence was detected in any of the patients. CONCLUSIONS The RFID marking system accurately informed the surgeons of the tumor location and helped them to perform precise sublobar resection.
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Matsuoka S, Shimizu K, Koike S, Takeda T, Miura K, Eguchi T, Hamanaka K. Significance of the evaluation of tracheal length using a three-dimensional imaging workstation. J Thorac Dis 2022; 14:4276-4284. [PMID: 36524079 PMCID: PMC9745505 DOI: 10.21037/jtd-22-595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/23/2022] [Indexed: 11/27/2023]
Abstract
BACKGROUND Limited information is available on the total tracheal length and its other characteristics for tracheal surgery. This study aimed to investigate the reference value of tracheal length and assess its relationship with physiological variables. METHODS We measured the tracheal length of 215 patients (107 men and 108 women) who underwent contrast-enhanced computed tomography before thoracic surgery using a three-dimensional imaging workstation. Pearson correlation analysis and multiple linear regression analysis were performed to investigate the relationship between the total tracheal length (cervical and thoracic) and common physiological parameters. RESULTS The mean total tracheal length was 11.5±1 cm (range, 8.8-14.4 cm); 8% of the patients had a total tracheal length <10 cm. The cervical trachea was significantly shorter in men than in women (2.9±1.3 vs. 3.8±1.3 cm, P<0.001), whereas the thoracic trachea was significantly longer in men than in women (8.9±1.1 vs. 7.4±1.1 cm, P<0.001). Correlation analysis showed that the total tracheal length was positively associated with height in both sexes, while the height was positively associated with only cervical tracheal length. In the multiple linear regression analysis, the total tracheal length was influenced most by height, while cervical and thoracic tracheal lengths were influenced most by sex. Older age was also an independent contributor to a shorter cervical trachea and longer thoracic trachea in both sexes. CONCLUSIONS The total tracheal length ranged from short to long in individuals, and characteristics of tracheal length varied with height, age, sex, and part of the trachea. We should thus be aware of the tracheal length of each patient for appropriate tracheal management.
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Affiliation(s)
- Shunichiro Matsuoka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Sachie Koike
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsu Takeda
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kentaro Miura
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Eguchi
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazutoshi Hamanaka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Cui F, Liu J, Du M, Fan J, Fu J, Geng Q, He M, Hu J, Li B, Li S, Li X, Liao YD, Lin L, Liu F, Liu J, Lv J, Pu Q, Tan L, Tian H, Wang M, Wang T, Wei L, Xu C, Xu S, Xu S, Yang H, Yu BT, Yu G, Yu Z, Lee CY, Pompeo E, Azari F, Igai H, Kim HK, Andolfi M, Hamaji M, Bassi M, Karenovics W, Yutaka Y, Shimada Y, Sakao Y, Sihoe ADL, Zhang Y, Zhang Z, Zhao J, Zhong W, Zhu Y, He J. Expert consensus on indocyanine green fluorescence imaging for thoracoscopic lung resection (The Version 2022). Transl Lung Cancer Res 2022; 11:2318-2331. [PMID: 36519017 PMCID: PMC9742622 DOI: 10.21037/tlcr-22-810] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/21/2022] [Indexed: 08/27/2023]
Abstract
The use of the white-light thoracoscopy is hampered by the low contrast between oncologic margins and surrounding normal parenchyma. As a result, many patients with in situ or micro-infiltrating adenocarcinoma have to undergo lobectomy due to a lack of tactile and visual feedback in the resection of solitary pulmonary nodules. Near-infrared (NIR) guided indocyanine green (ICG) fluorescence imaging technique has been widely investigated due to its unique capability in addressing the current challenges; however, there is no special consensus on the evidence and recommendations for its preoperative and intraoperative applications. This manuscript will describe the development process of a consensus on ICG fluorescence-guided thoracoscopic resection of pulmonary lesions and make recommendations that can be applied in a greater number of centers. Specifically, an expert panel of thoracic surgeons and radiographers was formed. Based on the quality of evidence and strength of recommendations, the consensus was developed in conjunction with the Chinese Guidelines on Video-assisted Thoracoscopy, and the National Comprehensive Cancer Network (NCCN) guidelines on the management of pulmonary lesions. Each of the statements was discussed and agreed upon with a unanimous consensus amongst the panel. A total of 6 consensus statements were developed. Fluorescence-guided thoracoscopy has unique advantages in the visualization of pulmonary nodules, and recognition and resection of the anterior plane of the pulmonary segment. The expert panel agrees that fluorescence-guided thoracoscopic surgery has the potential to become a routine operation for the treatment of pulmonary lesions.
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Affiliation(s)
- Fei Cui
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Ming Du
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Junqiang Fan
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Junke Fu
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Qing Geng
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ming He
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Bin Li
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xukai Li
- Department of Thoracic Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yong-De Liao
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Lin
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Liu
- Department of Thoracic Surgery, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jian Liu
- Anqing Hospital Affiliated to Anhui Medical University (Anqing Municipal Hospital), Anqing, China
| | - Junhong Lv
- Department of Thoracic Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Mingsong Wang
- Department of Thoracic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tao Wang
- Department of Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Li Wei
- Department of Thoracic Surgery, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Chuan Xu
- Department of Thoracic Surgery, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Shidong Xu
- Department of Thoracic Surgery and Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Shun Xu
- Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Haoxian Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ben-Tong Yu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Guangmao Yu
- Department of Cardiothoracic Surgery, Shaoxing People’s Hospital, Shaoxing Hospital, Zhejiang University, Shaoxing, China
| | - Zhentao Yu
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
| | - Feredun Azari
- Department of Thoracic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Marco Andolfi
- Department of Thoracic Surgery, AOU Ospedali Riuniti of Ancona, Ancona, Italy
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto University, Kyoto, Japan
| | | | - Wolfram Karenovics
- Division of Thoracic and Endocrine Surgery, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Yojiro Yutaka
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto University, Kyoto, Japan
| | - Yoshihisa Shimada
- Department of Thoracic Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yukinori Sakao
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | | | - Yi Zhang
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhenfa Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Jun Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, China
| | - Wenzhao Zhong
- Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
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Arjomandi Rad A, Vardanyan R, Thavarajasingam SG, Zubarevich A, Van den Eynde J, Sá MPBO, Zhigalov K, Sardiari Nia P, Ruhparwar A, Weymann A. Extended, virtual and augmented reality in thoracic surgery: a systematic review. Interact Cardiovasc Thorac Surg 2021; 34:201-211. [PMID: 34542639 PMCID: PMC8766198 DOI: 10.1093/icvts/ivab241] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Extended reality (XR), encompassing both virtual reality (VR) and augmented reality, allows the user to interact with a computer-generated environment based on reality. In essence, the immersive nature of VR and augmented reality technology has been warmly welcomed in all aspects of medicine, gradually becoming increasingly feasible to incorporate into everyday practice. In recent years, XR has become increasingly adopted in thoracic surgery, although the extent of its applications is unclear. Here, we aim to review the current applications of XR in thoracic surgery. METHODS A systematic database search was conducted of original articles that explored the use of VR and/or augmented reality in thoracic surgery in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to December 2020. RESULTS Our search yielded 1494 citations, of which 21 studies published from 2007 to 2019 were included in this review. Three main areas were identified: (i) the application of XR in thoracic surgery training; (ii) preoperative planning of thoracic procedures; and (iii) intraoperative assistance. Overall, XR could produce progression along the learning curve, enabling trainees to reach acceptable standards before performing in the operating theatre. Preoperatively, through the generation of 3D-renderings of the thoracic cavity and lung anatomy, VR increases procedural accuracy and surgical confidence through familiarization of the patient's anatomy. XR-assisted surgery may have therapeutic use particularly for complex cases, where conventional methods would yield inadequate outcomes due to inferior accuracy. CONCLUSION XR represents a salient step towards improving thoracic surgical training, as well as enhancing preoperative planning and intraoperative guidance.
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Affiliation(s)
- Arian Arjomandi Rad
- Corresponding author. Department of Medicine, Faculty of Medicine, Imperial College London, London, UK. Tel:+447397572231; e-mail: (A. Arjomandi Rad)
| | | | | | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Michel Pompeu B O Sá
- Department of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, University of Pernambuco, Recife, Brazil
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Peyman Sardiari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
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Gossot D, Mariolo AV, Grigoroiu M, Bardet J, Boddaert G, Brian E, Seguin-Givelet A. Thoracoscopic complex basilar segmentectomies: an analysis of 63 procedures. J Thorac Dis 2021; 13:4378-4387. [PMID: 34422364 PMCID: PMC8339731 DOI: 10.21037/jtd-20-3521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/09/2021] [Indexed: 12/01/2022]
Abstract
Background Thoracoscopic complex basilar segmentectomies are technically demanding and challenging. We review our experience to check whether this complexity can lead to specific surgical issues or increased post-operative morbidity. Methods Complex basilar segmentectomies were defined as the anatomical resection of at least one segment composing the basilar pyramid, excluding S6. Data of patients who had an intention-to-treat thoracoscopic complex basilar segmentectomy were retrospectively collected from 2007 to 2019: indications, preoperative assessment, clinical features, operative technical aspects and early post-operative outcome. Results Sixty-three patients, 26 men (41%) and 37 women (59%) with a median age of 66 years and a median body mass index (BMI) of 26 kg/m2 were included. Interventions performed were mostly S9+10 (n=32) and S8 (n=12) segmentectomies. Forty-five planned operations (71%) were completed. Extension to a larger resection was necessary in 17 patients (27%) and 4 patients underwent conversion to open surgery (6%). Median operative time was 168 minutes with a median intraoperative bleeding of 30 mL. Complications occurred in 11 patients (17%). There was no mortality. Median length of pleural drainage was 2 days (range, 1–2 days) and median hospital stay 4 days. Conclusions The extension rate of complex basilar segmentectomy is higher than that of other sublobar resections but their post-operative morbidity is identical.
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Affiliation(s)
- Dominique Gossot
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Alessio Vincenzo Mariolo
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Madalina Grigoroiu
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Jérémy Bardet
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Guillaume Boddaert
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Emmanuel Brian
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France
| | - Agathe Seguin-Givelet
- Thoracic Department, Curie-Montsouris Thorax Institute-Institut Mutualiste Montsouris (IMM), Paris, France.,Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
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8
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Anayama T, Hirohashi K, Miyazaki R, Okada H, Yamamoto M, Orihashi K. Fluorescence visualization of the intersegmental plane by bronchoscopic instillation of indocyanine green into the targeted segmental bronchus: determination of the optimal settings. J Int Med Res 2021; 49:300060521990202. [PMID: 33567948 PMCID: PMC7883170 DOI: 10.1177/0300060521990202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective To determine the appropriate amount of indocyanine green for bronchial insufflation. Methods We enrolled 20 consecutive patients scheduled for anatomical segmentectomy in the Kochi Medical School Hospital. After inducing general anesthesia, 6 to 60 mL of 200-fold-diluted indocyanine green (0.0125 mg/mL) was insufflated into the subsegmental bronchi in the targeted pulmonary segmental bronchus. The volume of the targeted pulmonary segments was calculated using preoperative computed tomography. Fluorescence spread in the segmental alveoli was visualized using a dedicated near-infrared thoracoscope. Results The targeted segment was uniformly visualized by indocyanine green fluorescence in 16/20 (80.0%) cases after insufflating indocyanine green. A receiver operating characteristic curve indicated that the area under the curve was 0.984; the optimal cut-off volume of diluted indocyanine green for insufflation was 8.91% of the calculated targeted pulmonary segment volume. Conclusions The setting for indocyanine green insufflation was optimized for near-infrared fluorescence image-guided anatomical segmentectomy. By injecting the correct amount of indocyanine green, fluorescence-guided anatomical segmentation may be performed more appropriately.
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Affiliation(s)
- Takashi Anayama
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan.,Center for Photodynamic Medicine, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Kentaro Hirohashi
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Ryohei Miyazaki
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Hironobu Okada
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Marino Yamamoto
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Kazumasa Orihashi
- Department of Surgery II, Kochi Medical School, Kochi University, Nankoku, Japan
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Chen-Yoshikawa TF, Fukui T, Nakamura S, Ito T, Kadomatsu Y, Tsubouchi H, Ueno H, Sugiyama T, Goto M, Mori S, Ozeki N, Hakiri S, Kawaguchi K. Current trends in thoracic surgery. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 82:161-174. [PMID: 32581397 PMCID: PMC7276403 DOI: 10.18999/nagjms.82.2.161] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Thoracic surgery has evolved drastically in recent years. Although thoracic surgeons mainly deal with tumorous lesion in the lungs, mediastinum, and pleura, they also perform lung transplantation surgery in patients with end-stage lung disease. Herein, we introduce various major current topics in thoracic surgery. Minimally invasive surgical procedures include robot-assisted thoracic surgery and uniportal video-assisted thoracic surgery. Novel techniques for sublobar resection include virtual-assisted lung mapping, image-guided video-assisted thoracic surgery, and segmentectomy using indocyanine green. Three-dimensional (3D) computed tomography (CT) simulation consists of surgeon-friendly 3D-CT image analysis systems and new-generation, dynamic 3D-CT imaging systems. Updates in cadaveric lung transplantation include use of marginal donors, including donation after circulatory death, and ex vivo lung perfusion for such donors. Topics in living donor lobar lung transplantation include size matching, donor issues, and new surgical techniques. During routine clinical practice, thoracic surgeons encounter various pivotal topics related to thoracic surgery, which are described in this report.
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Affiliation(s)
| | - Takayuki Fukui
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shota Nakamura
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshinari Ito
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuka Kadomatsu
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Tsubouchi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Harushi Ueno
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoshi Sugiyama
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Goto
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Mori
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ozeki
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shuhei Hakiri
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Kawaguchi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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10
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Yang W, Liu Z, Yang C, Liu S, Guo M, Wen W, Wang J, Liu C, Zhu Q. Combination of nitrous oxide and the modified inflation-deflation method for identifying the intersegmental plane in segmentectomy: A randomized controlled trial. Thorac Cancer 2021; 12:1398-1406. [PMID: 33817992 PMCID: PMC8088974 DOI: 10.1111/1759-7714.13919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/26/2022] Open
Abstract
Background During thoracoscopic segmentectomy, accurately and rapidly identifying the intersegmental plane (ISP) is of great importance. This study aimed to investigate the effect and safety of a nitrous oxide (N2O)/oxygen (O2) inspired mixture on the appearance time of the ISP (TISP) via the modified inflation‐deflation method. Methods A total of 65 participants who underwent segmentectomy were randomized into three groups: 75% N2O (n = 24), 50% N2O (n = 23) or 0% N2O (n = 18). The 75% N2O group received a gas mixture of N2O/O2 (Fio2 = 0.25), the 50% N2O group received N2O/O2 (Fio2 = 0.5), and the 0% N2O group received 100% oxygen during lung expansion. The appearance time of satisfactory and ideal planes was recorded. Furthermore, arterial blood gas at breathing room air, one‐lung ventilation (OLV) before lung expansion, 5 and 15 min after lung expansion were also recorded. Results TISP was significantly shorter in the 75% N2O group (320.2 ± 65.9 s) compared with that of the 50% N2O group (552.4 ± 88.9 s, p < 0.001) and the 0% N2O group (968.3 ± 85.5 s, p < 0.001), while the 50% N2O group was shorter than that of the 0% N2O group (p < 0.001). Arterial oxygenation was significantly improved in the 0% N2O group only after lung expansion, before which there were no differences in mean PaO2 values among groups. Conclusions The use of N2O in the inspired gas mixture during lung expansion is an applicable strategy to rapidly identify the ISP via the modified inflation‐deflation method without any adverse effect on OLV related arterial oxygenation during segmentectomy.
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Affiliation(s)
- Wenjing Yang
- Department of AnesthesiologyJiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Zicheng Liu
- Department of Thoracic SurgeryJiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Chun Yang
- Department of AnesthesiologyJiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Shijiang Liu
- Department of AnesthesiologyJiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Minna Guo
- Department of AnesthesiologyJiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Wei Wen
- Department of Thoracic SurgeryJiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Jun Wang
- Department of Thoracic SurgeryJiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Cunming Liu
- Department of AnesthesiologyJiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Quan Zhu
- Department of Thoracic SurgeryJiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
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11
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Sekine Y, Koh E, Hoshino H. The efficacy of transbronchial indocyanine green instillation for fluorescent-guided wedge resection. Interact Cardiovasc Thorac Surg 2021; 33:51-59. [PMID: 33729468 DOI: 10.1093/icvts/ivab054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/13/2021] [Accepted: 01/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The purpose of this study was to investigate the feasibility of lung wedge resection by combining 3-dimensional (3D) image analysis with transbronchial indocyanine green (ICG) instillation, in order to delineate the intended area for resection. METHODS From December 2017 to July 2020, 28 patients undergoing wedge resection (17 primary lung cancers, 11 metastatic lung tumours) were enrolled, and fluorescence-guided wedge resection was attempted. Virtual sublobar resections were created preoperatively for each patient using a 3D Image Analyzer. Surgical margins were measured in each sublobar resection simulation in order to select the most optimal surgical resection area. After transbronchial instillation of ICG, near-infrared thoracoscopic visualization allowed matching of the intended area for resection to the virtual sublobar resection area. To investigate the effectiveness of ICG instillation, the clarity of the ICG-florescent border was evaluated, and the distance from the true tumour to the surgical margins was compared to that of simulation. RESULTS Mean tumour diameter was 12.4 ± 4.3 mm. The entire targeted tumour was included in resected specimens of all patients (100% success rate). The shortest distances to the surgical margin via 3D simulation and by actual measurement of the specimen were11.4 ± 5.4 and 12.2 ± 4.1 mm, respectively (P = 0.285) and were well correlated (R2 = 0.437). While all specimens had negative malignant cells at the surgical margins, one loco-regional recurrence was observed secondary to the dissemination of neuroendocrine carcinoma. CONCLUSIONS ICG-guided lung wedge resection after transbronchial ICG instillation and preoperative 3D image analysis allow for adequate negative surgical margins, providing decreased risk of local recurrence.
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Affiliation(s)
- Yasuo Sekine
- Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Eitetsu Koh
- Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Hidehisa Hoshino
- Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
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12
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Matsui T, Takahashi Y, Shirai S, Nakanishi K, Nakada T, Sakakura N, Haneda H, Okuda K, Nakanishi R, Kuroda H. Comparison of surgical outcomes between thoracoscopic anatomical sublobar resection including and excluding subsegmentectomy. Gen Thorac Cardiovasc Surg 2021; 69:850-858. [PMID: 33387332 DOI: 10.1007/s11748-020-01556-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/14/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Despite the ubiquitous utilization of anatomical sublobar resection for malignant lung tumors, the effectiveness and feasibility of subsegmentectomy remains unclear. This study therefore compared the perioperative outcomes between anatomical sublobar resection including (IS) and excluding (ES) subsegmentectomy. METHODS Patients who had undergone anatomical sublobar resection at our institution from January 2013 to March 2019 were retrospectively reviewed. Clinicopathologic characteristics and perioperative outcomes of the IS group (n = 58) were then analyzed the compared to those of the ES group (n = 203). RESULTS No statistically significant differences in age, sex, comorbidities, tumor location, preoperative pulmonary function, or tumor size on imaging were found between both groups. The IS group had significantly higher preoperative computed tomography-guided marking rates (40% vs. 18%; p < 0.01) and used significantly more staplers for intersegmental dissection than the ES group [4, interquartile range (IQR): 3-4 vs. 3, IQR: 3-4; p = 0.03]. Both groups had comparable 30-day mortality (0% vs. 0%; p > 0.99), intraoperative complications (7% vs. 10%; p = 0.61), and postoperative complications (5% vs. 8%; p = 0.58). After propensity score matching, the IS group experienced significantly lesser blood loss than the ES group (5 mL, IQR: 1-10 vs. 5 mL, IQR: 5-20; p = 0.03). Both groups experienced no local recurrence and demonstrated similar postoperative pulmonary functions after surgery. CONCLUSIONS IS may be a feasible and acceptable therapeutic option for malignant lung tumors. Nonetheless, future investigations are required to further validate the current findings.
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Affiliation(s)
- Takuya Matsui
- Department of Thoracic Surgery, Aichi Cancer Center, 1-1 Kanokoden Chikusa-ku, Nagoya, 464-8681, Japan.,Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho Mizuho-ku, Nagoya, 467-8602, Japan
| | - Yusuke Takahashi
- Department of Thoracic Surgery, Aichi Cancer Center, 1-1 Kanokoden Chikusa-ku, Nagoya, 464-8681, Japan.
| | - Suguru Shirai
- Department of Thoracic Surgery, Aichi Cancer Center, 1-1 Kanokoden Chikusa-ku, Nagoya, 464-8681, Japan
| | - Keita Nakanishi
- Department of Thoracic Surgery, Aichi Cancer Center, 1-1 Kanokoden Chikusa-ku, Nagoya, 464-8681, Japan
| | - Takeo Nakada
- Department of Thoracic Surgery, Aichi Cancer Center, 1-1 Kanokoden Chikusa-ku, Nagoya, 464-8681, Japan
| | - Noriaki Sakakura
- Department of Thoracic Surgery, Aichi Cancer Center, 1-1 Kanokoden Chikusa-ku, Nagoya, 464-8681, Japan
| | - Hiroshi Haneda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho Mizuho-ku, Nagoya, 467-8602, Japan
| | - Katsuhiro Okuda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho Mizuho-ku, Nagoya, 467-8602, Japan
| | - Ryoichi Nakanishi
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho Mizuho-ku, Nagoya, 467-8602, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center, 1-1 Kanokoden Chikusa-ku, Nagoya, 464-8681, Japan
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13
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Ferrari-Light D, Geraci TC, Sasankan P, Cerfolio RJ. The Utility of Near-Infrared Fluorescence and Indocyanine Green During Robotic Pulmonary Resection. Front Surg 2019; 6:47. [PMID: 31448283 PMCID: PMC6696346 DOI: 10.3389/fsurg.2019.00047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/23/2019] [Indexed: 12/17/2022] Open
Abstract
During minimally invasive pulmonary resection, it is often difficult to localize pulmonary nodules that are small (<2 cm), low-density/subsolid on imaging, or deep to the visceral pleura. The use of near-infrared fluorescence (NIF) imaging for localizing pulmonary nodules using indocyanine green (ICG) contrast is an emerging technology that is increasingly utilized during pulmonary resection. When administered via electromagnetic navigational bronchoscopy (ENB), ICG can accurately localize pulmonary nodules. When injected intravenously (IV), ICG can also help delineate the intersegmental plane. Research is ongoing regarding the utility of ICG for identification of the sentinel lymph node in lung cancer.
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Affiliation(s)
- Dana Ferrari-Light
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
| | - Travis C Geraci
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
| | - Prabhu Sasankan
- School of Medicine, New York University Langone Health, New York, NY, United States
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
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