研究目的
To develop a novel operation method for pulmonary sublobar resection that confirms an appropriate resection margin from the tumor and preserves pulmonary function.
研究成果
The method is applicable to any type of sublobar resection, allows initial determination of resection area at operation, enables super deep wedge resection without broncho-vascular transection with enough margin, provides long identification of fluorescence, and is indicated in case of COPD, IP, reoperation and adhesion. However, it requires specific equipment and skills, and has issues with ICG distribution.
研究不足
The necessity of a near infrared thoracoscopy and 3D medical image analyzer, knowledge of precise bronchial anatomy and advanced manipulation skills of bronchoscopy, ununiformity of ICG distribution and distribution of ICG into the adjacent area with the passage of time.
From Aug. 2014 to April 2018, 43 primary lung cancers were enrolled. Active limited resection was done in 29 and passive limited resection was done in 14. Preoperatively, each patient underwent computed tomography for creating several virtual sublobar resections by using Volume Analyzer Synapse VINCENT (Fujifilm, Tokyo, Japan). We measured the shortest distance from the tumor to the resection margin in each simulated resection and selected the most appropriate area of sublobar resection based on the adequate resection margin of approximately 2 cm from the tumor. After the simulation, we performed sublobar resection by using an infrared thoracoscopy with transbronchial ICG instillation. Before operation, 10ml of 10-fold diluted ICG with autologous blood and 400ml of air were instilled into each associated subsegmental bronchus. sublobar resection was performed under ICG visualization.
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