Abstract
ObjectiveTo investigate whether video-assisted thoracoscopic segmentectomy using near-infrared fluorescence imaging had better intersegmental plane visualization and peri-operative outcome in patients with chronic lung diseases.MethodsData were collected retrospectively from March 2014 and August 2019. A total of 92 patients with pulmonary nodules underwent near-infrared fluorescence guided uni-port thoracoscopic segmentectomy(NIF-VATS), 149 patients underwent thoracoscopic segmentectomy with inflation-deflation method(ID-VATS). After 1:1 propensity matching, perioperative outcomes between NIF-VATS and ID-VATS was compared.ResultsIncision size was 3 cm in both group.Mean operative time was 79 min in NIF-VATS group and 96 min in ID-VATS group. The intersegmental plane was not clear in 33 cases of ID-VATS group, and no clear boundary was found after prolonged waiting time. Emphysema or pulmonary bullae could be found in chest CT scan in these patients, they all were diagnosed as chronic obstructive pulmonary disease. In NIF-VATS group, the intersegmental plane was not clear in 8 cases. Under the guidance of three-dimensional reconstruction and preoperative positioning, the oncological margin length of both groups met the requirements of surgical quality control. The intraoperative blood loss, number of lymph node resection, showed no statistical difference between the two groups. Postoperative air leakage was more often observed in ID-VATS group. The postoperative drainage duration, postoperative hospitalization time was shorter in ID-VATS group.ConclusionsCompared with inflation-deflation method, segmentectomy using NIF imaging is feasible for patients with chronic lung diseases with better intersegmental plane, shorter operation time, less complications, it might lead to faster recovery.
Highlights
Lung cancer is a malignant tumor with the highest incidence and mortality in the world [1]
Near-Infrared Fluorescence (NIF) imaging with indocyanine green (ICG) is a recent advancement in segmentectomy with high success rates of intersegmental border visualization [5], the brightness of ICG fluorescence mainly depends on both the ICG concentration in blood vessels and the blood flow in the pulmonary artery, it might be beneficial in Video-Assisted Thoracoscopic Surgery (VATS) segmentectomy for patients with chronic lung diseases
The first near-infrared fluorescence guided thoracoscopic segmentectomy was performed in September 2017, the first thoracoscopic segmentectomy using inflationdeflation method was performed in March 2014, and the initial 30 cases were not included due to the learning curve effect [6], a total of 149 patients with chronic lung diseases were included in control group
Summary
Data were collected retrospectively from March 2014 and August 2019. A total of 92 patients with pulmonary nodules underwent near-infrared fluorescence guided uni-port thoracoscopic segmentectomy(NIF-VATS), 149 patients underwent thoracoscopic segmentectomy with inflation-deflation method(ID-VATS). After 1:1 propensity matching, perioperative outcomes between NIF-VATS and ID-VATS was compared
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