eISSN: 2299-0054
ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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4/2019
vol. 14
 
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abstract:
Original paper

Clinical study of video-assisted thoracoscopic surgery wedge resection in early-stage lung cancer by tumor mapping with indocyanine green

Liang Zhong
1
,
Weidong Hu
2
,
Shuping Li
3
,
Zhenhong Wei
4
,
Zijiang Zhu
1
,
Gang Jin
1
,
Hongyi Zhang
1
,
Yao Pang
1
,
Jun Yu
1

  1. Department of Thoracic Surgery, Gansu Province People’s Hospital, Lanzhou, China
  2. Department of Respiration, Gansu Province People’s Hospital, Lanzhou, China
  3. Department of Radiotherapy, Gansu Province People’s Hospital, Lanzhou, China
  4. Department of Clinical Laboratory, Gansu Province People’s Hospital, Lanzhou, China
Videosurgery Miniinv 2019; 14 (4): 545–550
DOI: https://doi.org/10.5114/wiitm.2019.89986
Online publish date: 2019/11/25
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Aim
This study aimed to assess the clinical effectiveness of video-assisted thoracoscopic surgery (VATS) in early-stage lung cancer by indocyanine green (ICG) for tumor mapping.

Material and methods
Thirty patients with early-stage lung cancer with peripheral nodules smaller than 2 cm scheduled for computed tomography (CT)-guided microcoil placement followed by ICG tumor mapping by VATS wedge resection were enrolled. After microcoil deployment, 100 to 150 ml of diluted ICG was injected percutaneously near the nodule. The nodule initially was localized solely by using a near-infrared ray (NIR) thoracoscope to visualize ICG fluorescence. Thoracoscopic instruments were used to determine the staple line. Wedge resection was performed after confirmation of the location of the microcoil using fluoroscopy and pathology results.

Results
Thirty patients underwent VATS resection. The median tumor size was 1.3 cm by CT. The median depth from the pleural surface was 1.7 cm (range: 0.5–3.8 cm). The median CT-guided intervention time was 25 min, and VATS procedural time was 50 min. ICG fluorescence was clearly identified in 30 of 30 patients (100%). The surgical margins were all negative on final pathology in all included cases. The final diagnoses were 30 primary lung cancers; none needed additional resection.

Conclusions
CT-guided percutaneous ICG injection and intraoperative NIR localization of small nodules are safe and feasible. These offer surgeons the ease of localization through direct indocyanine green fluorescence imaging without the use of fluoroscopy and may be a complementary technique to preoperative microcoil placement for nonvisible, nonpalpable intrapulmonary nodules.

keywords:

video-assisted thoracoscopic surgery, early-stage lung cancer, near-infrared ray, indocyanine green
  
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