Application Of 3D-CTBA Combined With Indocyanine Green Reverse Staining In Video Assisted Thoracic Segmentectomy

Objective:Video assisted thoracic surgery（VATS）segmentectomy has sprung up and developed rapidly in recent years.However,it still faces many technical challenges,especially in complex segmentectomy.In this study,three-dimensional computed tomographybronchography and angiography（3D-CTBA）and indocyanine green（ICG）reverse staining method were combined in VATS segmentectomy.Our objective was to evaluate the feasibility and perioperative outcomes of this method.Methods:This is a retrospective study which enrolls a number of 125 patients from January 2020 to January 2021.All of the surgical procedures were VATS segmentectomy,preoperatively using 3D-CTBA and intraoperatively using ICG reverse staining method.We divided the effect of intersegment plane display into three levels.Level 2（all inflation-deflation line are basically clearly displayed）or Level 3（all inflation-deflation line are clearly displayed）is perceived as success in ICG reverse staining method.According to the number of intersegmental planes to be created during the operation and the difficulty of dissecting vessels and bronchus,the patients were divided into complex segment group and simple segment group.In this study,the author uses SPSS 23.0 statistical software to process the data.Data conforming to a normal distribution are expressed as mean±standard deviation while between groups comparisons was done by using Independent-samples t-test.If the distribution was skewed,Data are expressed as median and inter-quartile range while between groups comparisons was done by using Mann-Whitney test.Categorical data were compared using the two-sided Fisher exact or Pearson chi-square tests.P≤0.05 was considered statistically significant.Results:The sample size contained 125 cases in this study,of which 85 cases were women（68%）,40 cases were men（32%）,whose average age was（54.8 ± 11.1）years.In the whole group,there were no relevant chest signs such as cough and chest pain before admission.Pulmonary nodules were all found on chest CT.The procedure was almost identical to the preoperative simulation.All intersegmental planes are displayed successfully by ICG reverse staining method.There were no allergic patients.A total of 130 pathological specimens were retrieved from 125 patients and the tumor size ranged from 4 mm to 20 mm with a mean of（9.8±4.0）mm.The pathological results showed that there were 50 cases of MIA（38.5%）,followed by 48 cases of IAC（36.9%）.Metastatic tumors were found in 3 cases（2.3%）,including primary malignant melanoma（2 years）,breast cancer（9 years）,and rectal cancer（1 years）.The patients were divided into complex segment group（81 cases）（64.8%）and simple segment group（44 cases）（35.2%）.After comparative analyses,a balanced baseline level was found in both groups.The median operative time was significantly longer in the complex group[135.0（53.0）min]than in the simple group[120.0（48.0）min].However,there were no significant differences between the two groups in intraoperative blood loss,postoperative hospital stay,postoperative duration of chest tube placement,overall complication rate,longterm air leak,postoperative pulmonary torsion,and perioperative death（P>0.05）.Conclusion:On the basis of good preoperative 3D-CTBA images,VATS segmentectomy can be safely and effectively completed by combining with ICG reverse staining method,which is worth clinical promotion and application.