[Thoracoscopic Segmentectomy Using Three-dimensional Computed Tomography and Indocyanine-green Fluorescence Navigation].

Background: We investigated the feasibility and efficacy of thoracoscopic segmentectomy using 3-dimensional computed tomography( 3D-CT) and indocyanine-green( ICG) fluorescence navigation.
Methods: ICG fluorescence-navigated thoracoscopic segmentectomy was performed in 149 patients during 2013 and 2017. Each patient underwent preoperative evaluation by thin-section enhanced CT, which provided 3-dimensional simulations of vascular and bronchial structures. During the procedure, low-dose ICG( 0.15~0.25 mg/kg) was injected systemically after the target segmental pulmonary arteries and bronchus were divided. Under near-infrared thoracoscopic guidance, an intersegmental plane was clearly observed as a border between dark target region and bright residual region. The ICG fluorescent line was marked by electrocautery, followed by division of lung parenchyma along the line by endoscopic staples.
Results: An intersegmental line was visible in 98% of patients by ICG fluorescence navigation. No ICG-related adverse events occurred. No operative mortality was observed and morbidity rate was 8.7%. The 5-year overall survival rate and the 5-year recurrence free probability of 101 patients with primary lung cancer were 92% and 98%, respectively. Local recurrence at the resected site occurred in no patient with lung cancer and 1 patient with pulmonary metastasis.
Conclusion: Thoracoscopic segmentectomy using 3D-CT and ICG fluorescence navigation is a useful therapeutic option.