Virtual Library

Start Your Search

Sasha Stamenkovic



Author of

  • +

    P2.17 - Treatment of Early Stage/Localized Disease (ID 189)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
    • +

      P2.17-12 - Robotic Assisted Segmentectomy - Intravenous vs Intrabronchial Fluorescence Thoracoscopy to Identify the Intersegmental Plane (Now Available) (ID 1961)

      10:15 - 18:15  |  Author(s): Sasha Stamenkovic

      • Abstract
      • Slides

      Background

      Increasingly earlier detection of small lung cancers may permit the possibility of anatomical sublobar resection. Robotic assisted thoracic surgery (RATS) facilitates complex segmentectomy but identification of the intersegmental boundary remains a drawback to minimally invasive techniques. We have employed two contrasting methods using either intravenous (IV) or intrabronchial (IB) indocyanine green (ICG) and compared the efficacy.

      Method

      The location of the lesion was identified on CT reconstruction. Patients were allocated to either method by surgeon preference. IV ICG was injected during RATS after division of the target segmental artery. A novel aerosolized IB technique (by fibreoptic bronchoscopy) was used to inject the target segmental bronchus before RATS. All operations were performed using the Da Vinci Xi robot (Intuitive Surgical, Sunnyvale, CA, USA) and near infrared thoracoscopy (Firefly®). IV ICG was administered in 18 patients and IB ICG was given in 13 patients. The intersegmental plane was identified by the fluorescence demarcation line, which was then divided using the robotic stapler.

      Result

      On univariate analysis, there were no intergroup differences between IV and IB in the patient demographics (median age 70.5 years vs 71 years), number of staple firings (8 vs 10, p>0.05), success in identifying the intersegmental plane (94 vs 100% respectively, p>0.05), postoperative air leak duration (2 vs 3 days, p >0.05), or TNM staging of tumours (T1 64% vs 86% respectively, p>0.05). The total anaesthetic time (230 vs 290 mins, p<0.05) and the operative duration (171.5 vs 193.5 mins, p<0.05) were significantly less in the IV ICG group. In IB ICG, more than half of the segmentectomies involved the apical segment of either lower lobe (5 R S6, 1 L S6; 3 L S1-3, 2L S4-5), whereas in IV ICG more complex segmentectomies were performed (2 R S1-2, 2 R S6, 2 R S7-10; 2 L S1-2, 5 L S1-3, 2 L S4-5, 1 L S7-10, 1 L S7-8). There was no mortality nor major complications in either group. One case was converted to thoracotomy due to extensive adhesions in the IV ICG group. In the same group, there was one R1 resection due to parietal pleura involvement.

      Comparison between IV and IB ICG in RATS segmentectomies

      Total number of
      patients
      IV ICG (n=18) IB IVG (n=13)


      Excluded patients

      1 case converted to thoracotomy
      1 wedge resection (frozen section negative)
      1 lobectomy (abnormal anatomy)
      Patient age (median,
      range)
      70.5 (35-84) 71 (50-89)
      Sex (M/F) 11/7 7/6





      Target segments (R/L)
      R S1-2 2

      R S6 2

      R S7-10 2

      L S1-2 2

      L S1-3 5

      L S4-5 2

      L S7-10 1

      L S7-8 1



      R S6 5

      L S1-3 3

      L S4-5 2

      L S6 1
      Operative duration
      (median, range)
      171.5 mins (111-228) 193.5 mins (178-275)
      No of staple firings
      (median, range)
      8 (2-14) 10 (7-15)
      Success in identifying the intersegmental
      plane (%)

      16/17 (94%)

      11/11 (100%)
      Major complications 0 0
      Conversion to VATS or
      open
      1(adhesions) 0
      Tumour clearance (%) R0 16/17 (94%) R0 11/11 (100%)
      NSCLC (%)

      T-status in NSCLC (%)
      NSCLC 14/17 (82%)

      T1 9/14 (64%)
      NSCLC 7/11 (63%)

      T1 6/7 (86%)
      Conclusion

      In RATS segmentectomy, identification of the intersegmental plane is facilitated by the intraoperative use of ICG. Both IV and IB routes are feasible with comparable results. As the IV route appears to reduce the use of theatre time, a future randomized comparison is suggested.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.