研究目的
To investigate the feasibility of a novel approach combining 3D Image Analyzer and infrared thoracoscopy with transbronchial instillation of indocyanine green for precise anatomical sublobar resection in pulmonary surgery.
研究成果
The combination of preoperative simulation using 3D Image Analyzer and intraoperative fluorescence-guided surgery with transbronchial ICG instillation is feasible for precise anatomical sublobar resection, with a high success rate (89.2%) and concordance between simulation and actual resection (93.1%). This method enables complex resections with sufficient surgical margins, though it requires specialized equipment and expertise. Future multicenter studies are needed to evaluate long-term outcomes and comparative efficacy.
研究不足
1) Single-center non-comparative study; 2) Failed cases were excluded, and only successful cases were analyzed; 3) No comparison of long-term outcomes; 4) No separate evaluation of the contributions of transbronchial ICG instillation and virtual segmentectomy; 5) Necessity of advanced equipment and skills; 6) Potential for non-uniform ICG distribution and leakage into adjacent areas.
1：Experimental Design and Method Selection:
The study used a single-center, phase II feasibility test design. Preoperative simulation with 3D Image Analyzer (Synapse 3D VINCENT) was employed to create virtual sublobar resections and measure surgical margins. Intraoperative fluorescence-guided surgery was performed using infrared thoracoscopy after transbronchial instillation of indocyanine green (ICG).
2：Sample Selection and Data Sources:
Patients were selected based on inclusion criteria: early stage lung cancer (c-stage IA1 or IA2), metastatic lung tumors, benign diseases, or high-risk patients not candidates for lobectomy. Exclusion criteria included iodine allergy or patient refusal. Data from 65 enrolled cases (58 evaluated) were analyzed, with comparisons to a historical control group of 59 patients who underwent traditional thoracoscopic segmentectomy.
3：List of Experimental Equipment and Materials:
Equipment included 320-slice CT scanners (Aquilion ONE? / ViSION Edition, Toshiba Medical Systems), Volume Analyzer Synapse 3D VINCENT (Fujifilm co.), thin-bronchoscope (BF-P260F, Olympus Medical Co.), bronchial catheter with balloon (Olympus disposable balloon catheter B5-2C/2LA, Olympus Medical Co.), near-infrared thoracoscope (PINPOINT, Stryker), and materials such as indocyanine green (ICG), saline, autologous blood, and endotracheal tubes.
4：Experimental Procedures and Operational Workflow:
Preoperative: High-resolution CT and 3D imaging to simulate resections. Intraoperative: Transbronchial instillation of diluted ICG, followed by infrared thoracoscopy to visualize and mark resection borders, then anatomical sublobar resection via video-assisted thoracoscopic surgery (VATS). Postoperative: Comparison of pre- and postoperative CTs to evaluate concordance.
5：Data Analysis Methods:
Statistical analysis using SPSS Statistics 20, with Mann-Whitney U test for continuous variables and Chi-square test for categorical variables. Propensity score matching was used to compare groups, with p<0.05 considered significant.
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