Uniportal VATS Segmentectomy with Indocyanine Green Imaging

This video demonstrates a case of uniportal VATS segmentectomy with indocyanine green imaging. The patient was a sixty-five-year-old woman, nonsmoker, with a 12mm ground glass opacity in the apical segment of the right upper lobe. A lepidic adenocarcinoma of the lung was diagnosed by transbronchial biopsy. She had a patient performance status of 1, but her lung function test demonstrated an FEV1 of 102%.

Steps of the Surgery

Some adhesions were dissected before the dissection of the hilum. After the identification of the right upper lobe vein, the apical segment was isolated and then stapled with the endovascular stapler. The next step was to expose the segmental branches of the artery. We identified two apical branches, which were stapled. The segmental bronchus was then dissected and stapled. Next, an indocyanine green was injected into the blood via a peripheral vein, and the intersegmental plane was identified. The parenchyma was stapled, and the lung specimen was removed. Lymph node dissection was also performed, and the pulmonary ligament was dissected. Then three intercostal spaces were infiltrated with ropivacaine. Finally, a 24 French chest drain was inserted through the same incision.

The postoperative course was uneventful, and patient was discharged home on the sixth day.

References

1- Kato H, Oizumi H, Suzuki J, Hamada A, Watarai H, Sadahiro M. Thoracoscopic anatomical lung segmentectomy using 3D computed tomography simulation without tumour markings for non-palpable and non-visualized small lung nodules. Interact CardioVasc Thorac Surg 2017;25:434–41.

2- Tarumi S, Misaki N, Kasai Y, Chang SS, Go T, Yokomise H. Clinical trial of video-assisted thoracoscopic segmentectomy using infrared thoracoscopy with indocyanine green. Eur J Cardiothorac Surg. 2014 Jul;46(1):112-5. doi: 10.1093/ejcts/ezt565. Epub 2013 Dec 11. PMID: 24335267.