Advertisement

Surgical Endoscopy

, Volume 31, Issue 8, pp 3347–3348 | Cite as

Indocyanine green fluorescence-navigated robotic segmentectomy

  • Chen-Ping Hsieh
  • Yun-Hen Liu
  • Yi-Cheng Wu
  • Ming-Ju Hsieh
  • Yin-Kai ChaoEmail author
Video

Abstract

Background

Pulmonary segmentectomy with radical lymphadenopathy has been considered effective to manage small primary lung cancers [1, 2]. This procedure provides the advantages of minimal invasive surgery and is reported sufficient for safe margin. However, segmentectomy is more difficult to be performed than lobectomy because intersegmental plane cannot be detected easily. Several methods have been reported for identifying the actual intersegmental plane [3, 4, 5, 6, 7], but the sensitivity of these methods is limited to the lung conditions like patients with emphysematous lung and needed skilled surgeon to perform. We demonstrated the technique of visualizing the intersegmental plane via fluorescence navigated with indocyanine green (ICG) injection intravenously during robotic S6 segmentectomy.

Methods

This video presents a case that 70-year-old male who has past history of rectal cancer status post-LAR in 1991, HCC status post-RFA, and hepatitis C was found a lung nodule over superior segment of left lower lobe during regular examination. The nodule was considered metastatic tumor preoperatively. The segmental pulmonary artery and pulmonary bronchus to superior segment of left lower lobe were ligated firstly, and the intersegmental plane was seen clearly after ICG injection intravenously under fluorescence navigated. Intersegmental plane was marked by electrocautery, and then, the target segment was resected by endostapler.

Results

Patient tolerated the procedure well. Chest tube was removed by postoperative day 3, and he was discharged smoothly by postoperative day 5. There were no complications. Postoperative chest X-ray revealed good lung expansion. Not as preoperative expectation, the final pathology was consistent with caseating granulomatous inflammation.

Conclusion

It is difficult to identify intersegmental plane during segmentectomy. ICG fluorescence-navigated segmentectomy provides immediate visualization of the intersegmental plane and makes the procedure easy and fast.

Keywords

Indocyanine green Segmentectomy Robotic surgery 

Notes

Compliance with ethical standards

Disclosures

Chen-Ping Hsieh, Yun-Hen Liu, Yi-Cheng Wu and Ming-Ju Hsieh have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MOV 96241 kb)

References

  1. 1.
    Harada H, Okada M, Sakamoto T, Matsuoka H, Tsubota N (2005) Functional advantage after radical segmentectomy versus lobectomy for lung cancer. Ann Thorac Surg 80:2041–2045CrossRefPubMedGoogle Scholar
  2. 2.
    Leshnower BG, Miller DL, Fernandez FG, Pickens A, Force SD (2010) Video-assisted thoracoscopic surgery segmentectomy: a safe and effective procedure. Ann Thorac Surg 89:1571–1576CrossRefPubMedGoogle Scholar
  3. 3.
    Okada M, Mimura T, Ikegaki J, Katoh H, Itoh H, Tsubota N (2007) A novel video-assisted anatomic segmentectomy technique: selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. J Thorac Cardiovasc Surg 133:753–758CrossRefPubMedGoogle Scholar
  4. 4.
    Oizumi H, Kanauchi N, Kato H, Endoh M, Suzuki J, Fukaya K, Sadahiro M (2011) Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: a report of 52 consecutive cases. J Thorac Cardiovasc Surg 141:678–682CrossRefPubMedGoogle Scholar
  5. 5.
    Kanzaki M, Kikkawa T, Shimizu T, Maeda H, Wachi N, Isaka T, Murasugi M, Onuki T (2013) Presurgical planning using a three-dimensional pulmonary model of the actual anatomy of patient with primary lung cancer. Thorac Cardiovasc Surg 61:144–150CrossRefPubMedGoogle Scholar
  6. 6.
    Misaki N, Chang SS, Gotoh M, Yamamoto Y, Satoh K, Yokomise H (2009) A novel method for determining adjacent lung segments with infrared thoracoscopy. J Thorac Cardiovasc Surg 138:613–618CrossRefPubMedGoogle Scholar
  7. 7.
    Sekine Y, Ko E, Oishi H, Miwa M (2012) A simple and effective technique for identification of intersegmental planes by infrared thoracoscopy after transbronchial injection of indocyanine green. J Thorac Cardiovasc Surg 143:1330–1335CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Chen-Ping Hsieh
    • 1
    • 2
  • Yun-Hen Liu
    • 1
  • Yi-Cheng Wu
    • 1
  • Ming-Ju Hsieh
    • 1
  • Yin-Kai Chao
    • 1
    Email author
  1. 1.Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial HospitalLinkou; Chang Gung UniversityTaoyuanTaiwan
  2. 2.Division of Thoracic Surgery, Department of SurgeryShin Kong Wu Ho-Su Memorial HospitalTaipeiTaiwan

Personalised recommendations