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Detection of circulatory disturbance after pulmonary vein division during a living donor lobectomy

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Abstract

Indocyanine green (ICG) is widely used during thoracic surgery to enhance visualization, allowing assessment of the intersegmental plane based on intrapulmonary blood flow (Travis et al. in Ann Thorac Surg 108(2):363–369, 2019; Seshiru et al. in Gen Thorac Cardiovasc Surg 66(2):81–90, 2018). Using ICG to detect blood flow disruption after lung resection, however, has not been addressed. We therefore report a case in which the left lingular pulmonary vein was incidentally divided during left lower lobectomy in a living-lung donor. Intraoperative ICG-enhanced near-infrared fluoroscopic imaging to assess intrapulmonary blood flow detected the problem. We thus avoided potential postoperative residual lung complications in this patient.

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Acknowledgements

We thank Nancy Schatken, BS, MT(ASCP), from Edanz Group (https://en-author-services.edanzgroup.com/), for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan

    Yojiro Yutaka, Akihiro Ohsumi, Masatsugu Hamaji & Hiroshi Date

  2. Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

    Tatsuya Goto

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  1. Yojiro Yutaka
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  2. Tatsuya Goto
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  3. Akihiro Ohsumi
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  4. Masatsugu Hamaji
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  5. Hiroshi Date
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Correspondence to Yojiro Yutaka.

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1. After exposing the superior and inferior pulmonary veins, the inferior pulmonary vein was encircled. 2. We next exposed the interlobar pulmonary artery. 3. The anterior fissure was developed using a linear stapler. 4. After left lower lobectomy, indocyanine green was injected to assess the intrapulmonary blood flow. 5. Fluorescence was detected in the upper segment 15 s after the ICG injection. 6. Fifteen seconds after the ICG dye had appeared in the upper segment, it was seen gradually moving into the superior segment of the lingular segment. 7. However, it never reached the inferior segment of the lingular segment. 8. The inferior lingular segment, with no blood flow, was removed using a linear stapler to avoid potential postoperative complications. (MP4 266653 KB)

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Yutaka, Y., Goto, T., Ohsumi, A. et al. Detection of circulatory disturbance after pulmonary vein division during a living donor lobectomy. Gen Thorac Cardiovasc Surg 69, 770–773 (2021). https://doi.org/10.1007/s11748-020-01552-7

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  • DOI: https://doi.org/10.1007/s11748-020-01552-7

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