Fluorescence method versus modified inflation-deflation method distinguish intersegmental plane in thoracoscopic anatomical segmentectomy

Abstract

Objective To investigate the feasibility and security of fluorescence method in thoracoscopic anatomical segmentectomy, compared with modified inflation-deflation method. Methods Department of thoracic surgery of the First Medical Center, Chinese PLA General Hospital from Mar. 2017 to Sep. 2019, we performed thoracoscopic anatomical segmentectomy for 157 patients (fluorescence group, 41 females and 19 males, aging from 36 to 76; modified inflation-deflation group, 62 females and 35 males, aging from 27 to 85). In the fluorescence group, to distinguish intersegmental plane, indocyanine green was injected into peripheral vein after the targeted segmental artery cut off. In the modified inflation-deflation group, after the targeted segmental bronchus cut off, the bilateral ventilation was started, and then unilateral ventilation was restored. The intersegmental plane would be formed after more than 10 minutes. Clinical data of the two groups were collected and analyzed. Results Compared with the modified inflation-deflation group, the fluorescence group showed shorter display time and shorter operational time [20 s(8-25)s vs 1 008 s(884-1 200)s, P=0.031, (103.3±7.3)min vs (132.8±10.4)min, P=0.021]. There were no significant differences in bleeding volume, the number of lymph node dissection, drainage time, hospitalization time and morbidity between the two groups (all P>0.05). Conclusions Compared with modified inflation-deflation group, it is quicker and more accurate to distinguish intersegmental plane in fluorescence group. It needn′t to inflate and deflate lungs repeatedly. Fluorescence method is safe and efficient. Key words: Thoracoscopy; Segmentectomy; Fluorescence; Indocyanine green; Modified inflation-deflation