Real‐time Image‐guided Indocyanine Green Fluorescence Dual‐visualization Technique to Measure the Intraoperative Resection Margin During Thoracoscopic Segmentectomy

Aims The primary goal of thoracoscopic segmentectomy is the complete resection of early pulmonary carcinoma while sparing as much of the normal pulmonary parenchyma as possible, but an obvious trade-off exists between the pulmonary parenchymal preservation and an adequate resection margin. In this clinical trial, we explored a real-time image-guided indocyanine green (ICG) fluorescence dual-visualization technique to confirm the resection margin by improving the intraoperative localization of the pulmonary nodule and identification of the intersegmental boundary line (IBL). Methods This study was utilized in 35 patients with a screening-detected lung nodule <2 cm to complete thoracoscopic segmentectomy from December 2020 to June 2021. Computed tomography-guided localization of the pulmonary nodule with ICG solution was performed on the day of surgery. During the surgery, after dissecting the targeted pulmonary segmental arteries, ICG at 5 mg/body was injected into the systemic vein. Results We observed no toxicity. The dual-visualization technique was successfully implemented in all 35 patients to achieve a negative resection margin, which was more than 2 (mean 2.71 +/- 0.59) cm, or the size of the tumor based on the final pathological examinations. No intraoperative complications occurred and only one patient had postoperative prolonged air leaks, which was ceased 8 days later after conservative management without reoperation. Conclusions This method is a safe and feasible alternative to ensure a negative resection margin without removing an unreasonable amount of pulmonary parenchyma during pulmonary segmentectomy. Future studies will be needed to compare this method to alternative techniques in a clinical trial.