Is the near-infrared fluorescence imaging with intravenous indocyanine green method for identifying the intersegmental plane concordant with the modified inflation-deflation method in lung segmentectomy?

OBJECTIVES: At present, the modified inflation-deflation method is accepted and widely used in the clinic, but the near-infrared (NIR) fluorescence imaging with intravenous indocyanine green (ICG) method can also delineate the intersegmental demarcation. However, whether the two methods identify that the intersegmental plane is concordant with each other and match the real intersegmental demarcation is still unknown.

METHODS: Between March 2019 to July 2019, 19 consecutive segmentectomies were performed, using both methods to delineate the intersegmental plane, in order to evaluate and verify whether the intersegmental plane results created by the two methods were concordant and matched the real intersegmental demarcation.

RESULTS: Segmentectomies were carried out using uniportal video-assisted thoracic surgery (UVATS) successfully with no intraoperative conversions or ICG-related complications and only three cases (15.8%) with postoperative complications related to the operation. The intersegmental plane generated by the NIR fluorescence imaging with intravenous ICG method was found to be totally concordant with the modified inflation-deflation method that was approaching the real intersegmental demarcation in all 19 cases.

CONCLUSIONS: Both methods revealed the intersegmental plane clearly, and the NIR fluorescence imaging with intravenous ICG method was found to be totally concordant with the modified inflation-deflation method, which is highly concordant with the real intersegmental demarcation. NIR fluorescence imaging with intravenous ICG method may be more popular because of its safety, efficiency, and less complicated restrictions, especially in patients with pulmonary emphysema. Low doses of ICG do not affect the rate of identification of the intersegmental plane and is safer from drug toxicology.