Thoracoscopic Anatomical Lung Segmentectomy using Fluorescence Navigation with Indocyanine Green

Purpose: Detection of the intersegmental line during thoracoscopic segmentectomy is sometimes difficult. We describe a newly evolved technology using indocyanine green (ICG)-fluorescence navigation during this procedure. Description: We performed thoracoscopic right segments 8 and 9 anatomical segmentectomy on a 48-year-old man with pulmonary metastasis of osteosarcoma. Preoperative three-dimensional computed tomography revealed the relationships of the pulmonary artery and vein and segmental bronchi, and revealed the surgical margin of the segmental plane to measure 10 mm. During surgery, we separated the pulmonary artery, and then injected ICG 0.25 mg/kg into a peripheral vein. Using the KARL STORZ ICG system (KARL STORZ Endoscopy, Tokyo, Japan), we could observe that the residual segments were light and S8 and S9 were dark. We cut along the border created by this contrast, the intersegmental line, using electrocautery. Evaluation: This new technology allows easy detection of an intersegmental line and safe performance of thoracoscopic anatomical segmentectomy. Because this method does not require inflation of the lung, it is useful for thoracoscopic surgery. Conclusion: Intraoperative ICG-fluorescence navigation is useful in thoracoscopic segmentectomy. Mingyon Mun*, Sakae Okumura, Masayuki Nakao, Yosuke Matsuura, Junji Ichinose and Ken Nakagawa Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japan