演題

IS-9-4

Localization of small-sized pulmonary nodules using near-infrared fluorescence thoracoscopes

[演者] 穴山 貴嗣:1
[著者] 廣橋 健太郎:1, 宮崎 涼平:1, 岡田 浩晋:1, 久米 基彦:1, 佐藤 隆幸:2, 渡橋 和政:1
1:高知大学外科二, 2:高知大学循環制御学

Background: Video-assisted thoracoscopic wedge resection of multiple small, non-visible, and nonpalpable pulmonary nodules is a clinical challenge.Purpose: We propose an ultra-minimally invasive technique for localization of pulmonary nodules using local injection of indocyanine green (ICG) into lung parenchyma and intraoperative fluorescence detection with a nearinfrared (NIR) fluorescence thoracoscope.Methods: Fluorescence properties of ICG topically injected into the lung parenchyma were determined using a resected porcine lung. Local ICG injection and NIR fluorescence detection was demonstrated in a clinical trial. The ICG mixed with iopamidol was injected into the pulmonary nodules by CT guidance; ICG fluorescence was visualized by either Pin-point (Novadaq, Canada) or D-light P (Stortz, Germany); near-infrared (NIR) thoracoscopes.Results: The ICG existing under 24-mm depth of inflated lung was detectable by the NIR fluorescence thoracoscope. The size of the fluorescence spot made by 0.1 mL of ICG was 10.4 +/- 2.2 mm. An ICG and iopamidol spot remained at the injected point of the lung for more than 6 hours in vivo. In the clinical study, ICG was injected into pulmonary nodules with fine needle (23 gauge) , and the fluorescence was identified as a small sized spot at the pulmonary nodule with the NIR thoracoscope. The objective pulmonary nodules were resected with VATS. Surgical margins were negative in all cases (n=5). Conclusions: The local ICG injection and intraoperative NIR thoracoscopic detection is a feasible minimally invasive method to localize multiple pulmonary nodules.
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