A simple and effective technique for identification of intersegmental planes by infrared thoracoscopy after transbronchial injection of indocyanine green

ObjectivePulmonary segmentectomy has been recognized as an operative option for complete resection of early-stage lung cancer in patients with poor pulmonary function. However, identification of anatomic pulmonary segments is sometimes difficult in patients with emphysema. We developed an intraoperative method for identifying intersegmental planes of the lung with high-sensitivity infrared fluorescence imaging after transbronchial injection of indocyanine green.MethodsThe study included 10 patients with early-stage lung cancer who underwent thoracoscopic segmentectomy. Under general anesthesia, indocyanine green was injected into the bronchus of target pulmonary segments. The target segments of the lung were identified using the indocyanine green fluorescence endoscope (Hamamatsu Photonics, Hamamatsu, Japan). The intersegmental lines and planes were identified and allowed removal of the segments. To evaluate operative outcomes, we compared the indocyanine green injection group with a retrospective control group with 10 matched-pair patients who underwent traditional thoracoscopic segmentectomy.ResultsAccurate, real-time intraoperative detection of indocyanine green with an infrared thoracoscope was confirmed. Sparing of intersegments was safely performed using both staples and electric cautery. Furthermore, infrared thoracoscopy allowed visualization of any residual portion of resected segments after segmentectomy. There was no difference between the experimental indocyanine green and control groups in terms of operative time, duration of postoperative chest drainage, or postoperative complications. Length of stay was shorter in the indocyanine green group than in the control group (P = .055).ConclusionsTransbronchial indocyanine green injection into the relevant bronchus with the use of an infrared thoracoscope allows identification of intersegmental lines and planes during thoracoscopic segmentectomy

Endoscopic Nd:YAG Laser Treatment in the Perioperative Management of Tracheobronchoplasty

The objective of this study was to determine the role of endoscopic Nd:YAG laser treatment in the preoperative or postoperative management of tracheobronchoplasty. Eighteen patients with severe stenotic lesions of the trachea or bronchus underwent Nd:YAG laser treatment. Nd:YAG laser treatment was performed in the preoperative period in 14 patients and in the postoperative period in 4 patients. The indications for Nd:YAG laser treatment included emergency airway dilatation, confirmation of the distal margin of tumor, and safe tracheal intubation in patients with severe tracheal stenosis. The indications for Nd:YAG laser treatment in patients with severe stenosis of the mainstem bronchus were confirmation of the distal margin of tumor and recovery of lung ventilation during the preoperative period and reopening of the bronchial lumen to prevent obstructive pneumonia in the postoperative period. Among patients treated with Nd:YAG laser preoperatively, the indications were completely achieved in all 14 patients, except for 1 patient with adenoid cystic carcinoma who underwent treatment of the right mainstem bronchus. Among patients treated with Nd:YAG laser postoperatively the indications also were achieved in all 4 patients with severe granulomatous stenosis of the bronchial end-to-end anastomosis following sleeve lobectomy. In conclusion, endoscopic Nd:YAG laser treatment played an important role in the perioperative management of patients undergoing tracheobronchoplasty