Fluorescence-guided thoracic surgery

Abstract

Recently, the use of sublobar resection has become increasingly common for patients that were previously planned to undergo lobectomy. We encountered two challenges when performing sublobar resections for patients with small pulmonary nodules; one challenge was obtaining a sufficient surgical margin and the other was identifying the location of the nodules, especially in minimally invasive surgery. In recent years, indocyanine green (ICG) fluorescence has been used to solve these two problems in thoracic surgery: first, identifying the accurate intersegmental plane in anatomical lung segmentectomy for detecting the regions of residual pulmonary blood flow, and second, displaying the tumor location or optimal resection line intraoperatively as ICG virtual-assisted lung mapping (ICG-VAL-MAP). The purpose of this article is to present a review of the outcomes of fluorescence-guided thoracic surgery, and also our techniques in minimally invasive surgery using ICG fluorescence. We showed that patients received anatomical pulmonary resection that identified the intersegmental or interlobar plane using ICG guidance in video-assisted thoracic surgery (VATS) or in robot-assisted segmentectomy. We also showed that patients received pulmonary wedge resection, displaying the tumor location intraoperatively using ICG. Furthermore, we introduced a technique of preoperative transbronchial lung marking for small lung nodules called ICG-VAL-MAP. Fluorescence guidance in minimally invasive thoracic surgery makes it possible to ensure a safe surgical margin and identify the intersegmental line and location of the nodules accurately.