OA15.05 Anatomical Pulmonary Segmentectomy and Sub-Sebmentectomy for Lung Cancer Using the Novel Fluorescence Technique with Vitamin B2

Abstract

The identification of an accurate segment is essential for successful anatomic pulmonary segmentectomy. We have previously developed a new fluorescence technique using a PDD endoscope systemTM and vitamin B2 for identification of pulmonary segments in animal experiments. In this study, we applied this technique clinically to examine the efficacy and safety in anatomical pulmonary segmentectomy and sub-segmentectomy for pulmonary malignancies. Our technique requires two key instruments, a PDD endoscope systemTM(KARL STORZ GmbH and Co., Tuttlingen, Germany) as a fluorescence sensing device and vitamin B2 solution as a fluorescent substance. 17 patients with small lung nodules were enrolled in this study. Regarding our surgical technique, after identification of the target segmental or sub-segmental bronchus, vitaminB2 solution is injected via the bronchus. The target segment is identified as a fluorescent segment with the PDD endoscope systemTM. The identified segment is resected with an electric cautery, stapling devices, or combination of them. In case patient’s lung has severe abnormal change such as emphysema or fibrosis, another technique is indicated. After ligation of the target segmental or sub-segmental artery, vitaminB2 solution is systemically administrated with intravenous injection. The target segment is identified as a defect of fluorescence with the PDD endoscope systemTM. Following outcomes were collected; success rate of identifying the pulmonary segments, pathological evaluation of dissection margin, duration of chest drainage, and perioperative complications. A total of 18 procedures were performed using this technique. Performed segmentectomy or sub-segmentectomy were as follows; Right S1, S2, S3, S2a+3b, S6, S9, Left S1+2, S3, S4+5, S6, S8a+9b, S9+10. Resected nodules were 14 primary lung cancers, 1 MALT-lymphoma, 1 metastatic lung cancer, and 2 benign lung nodules. Histology of primary lung cancer was adenocarcinoma in all 14 cases. Pathological stage of lung cancer was 12 stageIA (pT1a; 10, pT1b; 2), 1 stageIIA (pT1aN1), and 1 stageIIIA (pT1aN2). The success rate of identifying pulmonary segments was 100%. Dissection of segmental border was performed with only electric cautery in 12 procedures, and with both of electric cautery and stapling device in 6 procedures. In all cases, no cancer cells were found on the resection margin pathologically. Mean drainage time was 1.7 days (1-4 days). Regarding perioperative complications, veno-vagal reflex was occurred after systemic injection of vitaminB2 in one case, and 1 delayed pneumothorax was found in one case. Our novel fluorescence technique involving a PDD endoscope systemTM and vitaminB2 allowed performing accurate and safe pulmonary segmentectomy and sub-segmentectomy.