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18839 Deniz REVISED.mp4 (1.15 GB)

Uniportal VATS Right Basal Segmentectomy with Indocyanine Green Imaging

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posted on 2023-02-21, 15:52 authored by Aris Koryllos

The video demonstrates a case of uniportal VATS right segmentectomy from S7 to S10 with indocyanine green imaging. The patient is a healthy thirty-nine-year-old woman with a typical endobronchial carcinoid which occluded the common bronchus of B8 to B10. The bronchus segments B6 and B7 were not affected. 

Using a uniportal approach, the basal trunk artery with A6 in the interlobar fissure of the right lower lobe was identified. With the intention to preserve segment 7 surgeons further identified A8–A10 with the separation of A7 and divided the common trunk artery of A8–A10 with an endovascular stapler. Next, the right lower lobe bronchus was dissected and the common bronchus for segments 8 to 10 was identified. Below the segment 7 bronchus, a bronchotomy was performed and it was discovered that the endoluminal tumor was visible directly above the resected area. The indication for a basilar segmentectomy was certain. The segment 7 artery and common basal trunk vein were then divided with the endovascular stapler without harming the segment 6 artery and vein. Then, the bronchotomy of the common bronchus for all basal segments was performed without harming segment 6.

After intravenous injection of indocyanine green, the intersegmental plane between segment 6 and the basal segments were marked and the lung parenchyma was stapled. 

The bronchus was sutured with 4-0 polydioxanone sutures. Between segment 6 and the middle lobe, a stabilizing suture was placed to avoid a torsion. The operation was finished after the exclusion of air leak.

The pathologic results showed a 10 x 5 x 5 mm typical carcinoid. The margins of the bronchus and vessels were clear, and the lymph nodes were free of tumor.  The TNM-classification was pT1a pN0 (0/12) L0 V0 Pn0 pR0, stage IA1. 

The patient will get a follow-up with a CT scan of the chest once a year. 

Suggested Reading

Fiala P, Petrásková K, Cernohorský S, Kinkor Z, Krepela E, Zatloukal P. Bronchial carcinoid tumors: long-term outcome after surgery. Neoplasma. 2003;50(1):60-65.

Swanson SJ. Segmentectomy for lung cancer. Semin Thorac Cardiovasc Surg. 2010;22(3):244-249. doi:10.1053/j.semtcvs.2010.10.014

Zhao X, Qian L, Luo Q, Huang J. Segmentectomy as a safe and equally effective surgical option under complete video-assisted thoracic surgery for patients of stage I non-small cell lung cancer. J Cardiothorac Surg. 2013;8:116. doi:10.1186/1749-8090-8-116

Jin Y, Wang M, Xue L, Zhao X. Clinical application of near-infrared thoracoscopy with indocyanine green in video-assisted thoracoscopic anatomical segmentectomy. Surg Innov. 2019;26(4):473-477. doi:10.1177/1553350619848197

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