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Shin Koyama

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    P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.16-42 - Indocyanine Green Intersegmental Visualization During Fluorescence Imaging of Thoracoscopic Anatomic Segmentectomy: A Novel Approach (ID 11844)

      16:45 - 18:00  |  Author(s): Shin Koyama

      • Abstract


      Anatomic segmentectomy (AS) of the lung is a more complex operative procedure than standard lobectomy, especially when performed as a complete thoracoscopic surgery. Identification of the intersegmental boundary line (IBL) is a technical imperative, allowing surgeons to develop this plane during segmentectomy. Although several methods of IBL identification (IBL-ID) have been reported, our general usage of an intravenous indocyanine green (ICG) fluorescence system is alternative. In examining 83 patients by conventional ICG method (CIM), the IBL-ID success rate was high (98.8%), but intersegmental visibility was diminished due to smoking and emphysema. We also examined 29 patients using the Spectra A method (SAM), which heightened intersegmental contrast (IC) and preserved segment brightness (PB), compared with CIM, thus improving intersegmental visibility. To effect further improvement, a trial of the novel SAM with xenon light (SAM-X) was undertaken.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We prospectively studied 106 consecutive patients who underwent complete thoracoscopic AS of 111 lung segments (including subsegments) at our Hospital between October 2015 and October 2017. Following intraoperative transection of the segmental artery, vein and bronchi, 5 mg/body weight of ICG was administered intravenously, and fluorescence images were generated using the ICG system. Both the CIM with xenon light (CIM-X) and the SAM-X were simultaneously obtained in concert for IBL-ID, quantifying intersegmental visibility for histogram representation.

      4c3880bb027f159e801041b1021e88e8 Result

      The patient population (men, 50; women, 56) had a mean age of 67.4±10.7 years and a mean Brinkman index of 446.6±650.7, harboring malignant lung tumors (primary, 77; metastatic, 29, other, 5) as follows: right upper, 28; right middle, 1; right lower, 20; left upper, 38; left lower, 24. IBL-ID was achieved in all patients (100%). As with the SAM apparatus, the SAM-X provided significantly better accentuation of green fluorescence in RGB light analysis, compared with the CIM-X (p<0.01). Furthermore, both IC and PB showed significant increases (p<0.01 each), whether comparing SAM-X with CIM-X or with SAM; and SAM-X was strong (R=0.8), surpassing that of CIM-X (R=0.39) as for the correlation between IC and PB.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The SAM-X device stabilized visibility and improved contrast between resected and non-resected segments and brightness of both resected and non-resected segments during thoracoscopic intersegmental identification.