Impact of indocyanine green on prolonged air leak in minimally invasive segmentectomy

BackgroundVideo-assisted thoracoscopic segmentectomies have become the gold standard for the treatment of early-stage non-small cell lung cancer less than two centimeters. The main difficulty is the identification of intersegmental boundary lines which dictate postoperative morbidities.MethodsWe conducted a retrospective study to compare the perioperative outcomes of patients who underwent minimally invasive segmentectomy using the traditional deflation-inflation method or the novel indocyanine green (ICG) technique. Using a prospectively maintained database, we performed a retrospective analysis of 197 consecutive anatomical segmentectomies, from 2020 to 2023. Clinical effectiveness, postoperative complications, and histological data were compared.ResultsA total of 73 (37%) patients had the inflation-deflation method and 124 (63%) had the intravenous ICG method. There were no significant differences in chest tube duration, prolonged air leak, postoperative complications, and postoperative hospital stays. Surgical margin width was also similar between the two groups. The multivariable analysis confirmed these results. Lastly, intravenous ICG brought no additional value in complex segmentectomies.ConclusionThis monocentric and retrospective analysis found no added value of the intravenous ICG on the perioperative results of minimally invasive segmentectomies. The place of this novel technique in the surgical armamentarium remains to be defined. Specific indications such as complex segmentectomy or patients with chronic pulmonary disease require further study. Limited research exists on the use of indocyanine green (ICG) for determining the inter-segmental plane and its potential impact on air leaks. Our comparative study, involving 197 patients, confronts ICG with the traditional inflation-deflation method for minimally invasive segmentectomy. We found no significant difference in postoperative outcomes, including chest drainage duration, prolonged air leak occurrence, hospital stay length, and pathological results. Despite its widespread use in developed nations, the validation of its efficacy remains pending. ICG, indocyanine green; ISP, intersegmental plane; MID, inflation-deflation method; MIV, indocyanine green method; NSCLC, non-small cell lung cancer. image