F-150
PROSPECTIVE STUDY OF NEAR-INFRARED THORACOSCOPY FOR INTERSEGMENTAL PLANE IDENTIFICATION DURING VIDEO-ASSISTED THORACOSCOPIC SEGMENTECTOMY Free

Objectives: Segmentectomy by video-assisted thoracoscopic surgery (VATS) allows anatomical resection for diagnosis and treatment of small lung nodules, but identification of the intersegmental planes remains difficult. The purpose of this study is to assess the usefulness of near-infrared thoracoscopy (NIT) for this identification.

Methods: From November 2014 to October 2015, 22 consecutive VATS segmentectomies were performed with NIT at our institution. Segmental localisation and anatomical vascular supply were identified on preoperative computed tomography, before VATS with systemic indocyanine green (ICG) injection after arterial ligation.

Results: Segmentectomies were all feasible by VATS, and intersegmental plane identification by NIT was good in all 22 cases. NIT was particularly helpful for the identification of the limits of atypical segments. NIT also provided an additional support in case of difficulty with anatomical vascular segmentation: for assessment of the distribution of an artery before its section, for assessment of vascular supply of the remaining lung, and for the distinction between segmental and intersegmental veins thus enhancing the quality and security of the resection. Three patients were intentionally converted to lobectomy for oncological reasons, by thoracotomy in one case. Postoperative course was uneventful for 18 patients, and complicated with two prolonged air leaks (10 and 15 days) and pneumonia for one patient, one gastroparesis and one colonic subileus. Drain was removed before the 3rd postoperative day except for the two mentioned patients; the mean hospital stay was 5.4 days (±4.5). All four benign lesions and 18 primary lung cancers were completely removed, including 14 stages IA, 2 IIA and 2 IIIA.

Conclusion: NIT provides a technical support for the identification of the intersegmental during VATS, and facilitates vascular identification. It contributes to the quality of segmentectomy for diagnostic and therapeutic excisions of small nodules which are often not visible and not palpable during VATS.

Disclosure: No significant relationships.