grekovВестник хирургии имени И.И. ГрековаGrekov's Bulletin of Surgery0042-46252686-7370Federal State Budgetary Educational Institution of Higher Education «Academician I.P. Pavlov First St. Petersburg State Medical University» of the Ministry of Healthcare of the Russion Federation, FSBEI HE I.P.Pavlov SPbSMU MOH Russia10.24884/0042-4625-2017-176-4-75-82grekov-252Research ArticleОПЫТ РАБОТЫEXPERIENCE OF WORKПЕРВЫЙ ОПЫТ ПРИМЕНЕНИЯ ФЛЮОРЕСЦЕНЦИИ С ИНДОЦИАНИНОМ ЗЕЛЁНЫМ ДЛЯ ОПРЕДЕЛЕНИЯ СЕГМЕНТАРНЫХ ГРАНИЦ ПРИ ТОРАКОСКОПИЧЕСКИХ СЕГМЕНТЭКТОМИЯХThe first experience of application of ICG-fluorescence for detection of segmental plane formation in thoracoscopic segmentectomyПищикВ. Г.PishchikV. G.vadim.pischik@mail.ruКоваленкоА. И.KovalenkoA. I.kovalenko.th@gmail.comЗинченкоЕ. И.ZinchenkoE. I.evgeniy-zinchenko@yandex.ruОборневА. Д.ObornevA. D.nurnberghd@mail.ruКлиническая больница № 122 Федерального медико-биологического агентства РФ; Санкт-Петербургский государственный университетРоссияClinical Hospital № 122; Saint-Petersburg State UniversityRussian FederationСанкт-Петербургский государственный университетРоссияSaint-Petersburg State UniversityRussian Federation20172808201717647582Copyright © Пищик В.Г., Коваленко А.И., Зинченко Е.И., Оборнев А.Д., 20172017Пищик В.Г., Коваленко А.И., Зинченко Е.И., Оборнев А.Д.Pishchik V.G., Kovalenko A.I., Zinchenko E.I., Obornev A.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.vestnik-grekova.ru/jour/article/view/252

ЦЕЛЬ ИССЛЕДОВАНИЯ. Оценка первого европейского опыта флюоресцентной торакоскопии с индоцианином зеленым в спектре света, приближенного к инфракрасному, при торакоскопических сегментэктомиях. МАТЕРИАЛ И МЕТОДЫ. В течение 2016 г. выполнены 21 торакоскопическая сегментэктомия. Интраоперационно после пересечения сосудов и бронха внутривенно вводили индоцианин в дозе 0,15 мг/кг массы тела, монополярной коагуляцией маркировали линию резекции по границе флюоресценции. РЕЗУЛЬТАТЫ. Точно определить межсегментарные границы по флюоресценции удалось у 18 больных. Средняя продолжительность интенсивной флюоресценции составила 95 с, что оказалось достаточно для маркирования межсегментарной линии резекции. У 2 больных интраоперационная верификация не удалась вследствие технических ошибок. У третьего пациента достаточной флюоресценции удалось добиться после введения дополнительной дозы индоцианина. Ни у одного из пациентов не выявлено осложнений, связанных с введением препарата. ЗАКЛЮЧЕНИЕ. Флюоресценция является безопасным и эффективным методом верификации анатомических границ сегментов. Ее внедрение существенно облегчает проведение торакоскопических сегментэктомий. Одноволновые оптические системы позволяют работать с более низкими дозами индоцианина зеленого.

OBJECTIVE. The authors evaluated the first European experience of fluorescence thoracoscopy with indocyanine green (ICG) in light spectrum which was approximated to near-infrared (NIR) in thoracoscopic segmentectomy (VATS segmentectomy). MATERIALS AND METHODS. The study covered 21 patients who underwent thoracoscopic segmentectomy during 2016. The ICG (0,15 mg/kg of body weight) was injected intravenously after dominant pulmonary artery ligation during operation. The boundary line between areas was marked by electrocautery at the border of fluorescence. RESULTS. The well-defined fluorescence borders were observed in 18 out of 21 patients (85,7 %). The median duration of intensive ICG staining was 95 sec and that was enough to mark intersegmental plane. The intraoperative verification was unsuccessful in 2 patients due to technical reasons. The first attempt of identification for the patient with severe COPD had unconvincing results and an additional ICG injection was used to achieve the precise fluorescence. There wasn’t revealed any complications associated with ICG injection. CONCLUSIONS. The ICG fluorescence is safe and effective method of segmental plane location. The implementation of this method significantly facilitates in thoracoscopic segmentectomy. The NIR fluorescence imaging systems allow clinicians to work with lower doses of ICG.

торакоскопическая сегментэктомияиндоцианин зеленыйфлюоресценцияthoracoscopic segmentectomyindocyanine green (ICG)fluorescenceReferencesChurchill E. D., Belsey R. Segmental pneumonectomy in bronchoectasis : the lingular segment of the left upper lobe // Ann. Surg. 1939. Vol. 109. P. 481-499.Churchill E. D., Belsey R. Segmental pneumonectomy in bronchoectasis : the lingular segment of the left upper lobe // Ann. Surg. 1939. Vol. 109. P. 481-499.De Zoysa M. K., Hamed D., Routledge T., Scarci M. Is limited pulmonary resection equivalent to lobectomy for surgical management of stage I non-small-cell lung cancer? // Interact. Cardiovasc. Thorac. Surg. 2012. Vol. 14. P. 816-820.De Zoysa M. K., Hamed D., Routledge T., Scarci M. Is limited pulmonary resection equivalent to lobectomy for surgical management of stage I non-small-cell lung cancer? // Interact. Cardiovasc. Thorac. Surg. 2012. Vol. 14. P. 816-820.Desmettre T., Devoisselle J. M., Mordon S. Fluorescence properties and metabolic features of indocyanine green (ICG) as related to angiography // Surv. Ophthalmol. 2000. Vol. 45. P. 15-27.Desmettre T., Devoisselle J. M., Mordon S. Fluorescence properties and metabolic features of indocyanine green (ICG) as related to angiography // Surv. Ophthalmol. 2000. Vol. 45. P. 15-27.Ginsberg R. J., Rubinstein L. V. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer // Ann. Thorac. Surg. 1995. Vol. 60. P. 615-622.Ginsberg R. J., Rubinstein L. V. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer // Ann. Thorac. Surg. 1995. Vol. 60. P. 615-622.Gotoh M., Okamoto T., Yamamoto Y., Yokomise H. Real time imaging and quantitative evaluation of the emphysematous lung by infrared thoracoscopy in experimental dogs // ASAIO J. 2005. Vol. 51. P. 148-151.Gotoh M., Okamoto T., Yamamoto Y., Yokomise H. Real time imaging and quantitative evaluation of the emphysematous lung by infrared thoracoscopy in experimental dogs // ASAIO J. 2005. Vol. 51. P. 148-151.Hwang Y., Kang C. H., Kim H. S. et al. Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy on the patients with non-small cell lung cancer : a propensity score matching study // Eur. J. Cardiothorac. Surg. 2015. Vol. 48. P. 273-278.Hwang Y., Kang C. H., Kim H. S. et al. Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy on the patients with non-small cell lung cancer : a propensity score matching study // Eur. J. Cardiothorac. Surg. 2015. Vol. 48. P. 273-278.Iizuka S., Kuroda H., Yoshimura K. et al. Predictors of indocyanine green visualization during fluorescence imaging for segmental plane formation in thoracoscopic anatomical segmentectomy // J. Thorac. Dis. 2016. Vol. 8. P. 985-991.Iizuka S., Kuroda H., Yoshimura K. et al. Predictors of indocyanine green visualization during fluorescence imaging for segmental plane formation in thoracoscopic anatomical segmentectomy // J. Thorac. Dis. 2016. Vol. 8. P. 985-991.Iwata H., Shirahashi K., Mizuno Y. et al. Surgical technique of lung segmental resection with two intersegmental planes // Interact. Cardiovasc. Thorac. Surg. 2013. Vol. 16. P. 423-425.Iwata H., Shirahashi K., Mizuno Y. et al. Surgical technique of lung segmental resection with two intersegmental planes // Interact. Cardiovasc. Thorac. Surg. 2013. Vol. 16. P. 423-425.Kamiyoshihara M., Kakegawa S., Ibe T., Takeyoshi I. Butterfly-needle video-assisted thoracoscopic segmentectomy : a retrospective review and technique in detail // Innovations (Phila). 2009. Vol. 4. P. 326-330.Kamiyoshihara M., Kakegawa S., Ibe T., Takeyoshi I. Butterfly-needle video-assisted thoracoscopic segmentectomy : a retrospective review and technique in detail // Innovations (Phila). 2009. Vol. 4. P. 326-330.Kasai Y., Tarumi S., Chang S. S. et al. Clinical trial of new methods for identifying lung intersegmental borders using infrared thoracoscopy with indocyanine green : comparative analysis of 2- and 1-wavelength methods // Eur. J. Cardiothorac. Surg. 2013. Vol. 44. P. 1103-1107.Kasai Y., Tarumi S., Chang S. S. et al. Clinical trial of new methods for identifying lung intersegmental borders using infrared thoracoscopy with indocyanine green : comparative analysis of 2- and 1-wavelength methods // Eur. J. Cardiothorac. Surg. 2013. Vol. 44. P. 1103-1107.Kuroda H., Dejima H., Mizumo T. et al. A new LigaSure technique for the formation of segmental plane by intravenous indocyanine green fluorescence during thoracoscopic anatomical segmentectomy // J. Thorac. Dis. 2016. Vol. 8. P. 1210-1216.Kuroda H., Dejima H., Mizumo T. et al. A new LigaSure technique for the formation of segmental plane by intravenous indocyanine green fluorescence during thoracoscopic anatomical segmentectomy // J. Thorac. Dis. 2016. Vol. 8. P. 1210-1216.Leshnower B. G., Miller D. L., Fernandez F. G. et al. Video-assisted thoracoscopic surgery segmentectomy: a safe and effective procedure // Ann. Thorac. Surg. 2010. Vol. 89. P. 1571-1576.Leshnower B. G., Miller D. L., Fernandez F. G. et al. Video-assisted thoracoscopic surgery segmentectomy: a safe and effective procedure // Ann. Thorac. Surg. 2010. Vol. 89. P. 1571-1576.Li H., Zhou J., Chi C. et al. Clinical application of near-infrared thoracoscope with indocyanine green in video-assisted thoracoscopic bullectomy // J. Thorac. Dis. 2016. Vol. 8. P. 1841-1845.Li H., Zhou J., Chi C. et al. Clinical application of near-infrared thoracoscope with indocyanine green in video-assisted thoracoscopic bullectomy // J. Thorac. Dis. 2016. Vol. 8. P. 1841-1845.Misaki N., Chang S. S., Gotoh M. et al. A novel method for determining adjacent lung segments with infrared thoracoscopy // J. Thorac. Cardiovasc. Surg. 2009. Vol. 138. P. 613-618.Misaki N., Chang S. S., Gotoh M. et al. A novel method for determining adjacent lung segments with infrared thoracoscopy // J. Thorac. Cardiovasc. Surg. 2009. Vol. 138. P. 613-618.Misaki N., Chang S. S., Igai H. et al. New clinically applicable method for visualizing adjacent lung segments using an infrared thoracoscopy system // J. Thorac. Cardiovasc. Surg. 2010. Vol. 140. P. 752-756.Misaki N., Chang S. S., Igai H. et al. New clinically applicable method for visualizing adjacent lung segments using an infrared thoracoscopy system // J. Thorac. Cardiovasc. Surg. 2010. Vol. 140. P. 752-756.Nomori H., Mori T., Ikeda K. et al. Segmentectomy for selected cT1N0M0 non-small cell lung cancer : a prospective study at a single institute // J. Thorac. Cardiovasc. Surg. 2012. Vol. 144. P. 87-93.Nomori H., Mori T., Ikeda K. et al. Segmentectomy for selected cT1N0M0 non-small cell lung cancer : a prospective study at a single institute // J. Thorac. Cardiovasc. Surg. 2012. Vol. 144. P. 87-93.Oh S., Suzuki K., Miyasaka Y. et al. New technique for lung segmentectomy using indocyanine green injection // Ann. Thorac. Surg. 2013. Vol. 95. P. 2188-2190.Oh S., Suzuki K., Miyasaka Y. et al. New technique for lung segmentectomy using indocyanine green injection // Ann. Thorac. Surg. 2013. Vol. 95. P. 2188-2190.Oizumi H., Kato H., Endoh M. et al. Techniques to define segmental anatomy during segmentectomy // Ann. Cardiothorac. Surg. 2014. Vol. 3. P. 170-175.Oizumi H., Kato H., Endoh M. et al. Techniques to define segmental anatomy during segmentectomy // Ann. Cardiothorac. Surg. 2014. Vol. 3. P. 170-175.Okada M., Mimura T., Ikegaki J. et al. A novel video-assisted ana tomic segmentectomy technique : selective segmental inflation via bronchofiberoptic jet followed by cautery cutting // J. Thorac. Cardiovasc. Surg. 2007. Vol. 133. P. 753-758.Okada M., Mimura T., Ikegaki J. et al. A novel video-assisted ana tomic segmentectomy technique : selective segmental inflation via bronchofiberoptic jet followed by cautery cutting // J. Thorac. Cardiovasc. Surg. 2007. Vol. 133. P. 753-758.Sekine Y., Ko E., Oishi H., Miwa M. A simple and effective technique for identification of intersegmental planes by infrared thoracoscopy after transbronchial injection of indocyanine green // J. Thorac. Cardiovasc. Surg. 2012. Vol. 143. P. 1330-1335.Sekine Y., Ko E., Oishi H., Miwa M. A simple and effective technique for identification of intersegmental planes by infrared thoracoscopy after transbronchial injection of indocyanine green // J. Thorac. Cardiovasc. Surg. 2012. Vol. 143. P. 1330-1335.Sihoe A. D., Van Schil P. Non-small cell lung cancer: when to offer sublobar resection // Lung Cancer. 2014. Vol. 86. P. 115-120.Sihoe A. D., Van Schil P. Non-small cell lung cancer: when to offer sublobar resection // Lung Cancer. 2014. Vol. 86. P. 115-120.Speich R., Saesseli B., Hoffmann U. et al. Anaphylactoid reactions after indocyanine-green administration // Ann. Intern. Med. 1988. Vol. 109. P. 345-346.Speich R., Saesseli B., Hoffmann U. et al. Anaphylactoid reactions after indocyanine-green administration // Ann. Intern. Med. 1988. Vol. 109. P. 345-346.Sugimoto S., Oto T., Miyoshi K., Miyoshi S. A novel technique for identification of the lung intersegmental plane using dye injection into the segmental pulmonary artery // J. Thorac. Cardiovasc. Surg. 2011. Vol. 141. P. 1325-1327.Sugimoto S., Oto T., Miyoshi K., Miyoshi S. A novel technique for identification of the lung intersegmental plane using dye injection into the segmental pulmonary artery // J. Thorac. Cardiovasc. Surg. 2011. Vol. 141. P. 1325-1327.Tarumi S., Misaki N., Kasai Y. et al. Clinical trial of video-assisted thoracoscopic segmentectomy using infrared thoracoscopy with indocyanine green // Eur. J. Cardiothorac. Surg. 2014. Vol. 46. P. 112-115.Tarumi S., Misaki N., Kasai Y. et al. Clinical trial of video-assisted thoracoscopic segmentectomy using infrared thoracoscopy with indocyanine green // Eur. J. Cardiothorac. Surg. 2014. Vol. 46. P. 112-115.Wolf A. S., Richards W.G., Jaklitsch M. T. et al. Lobectomyversus sublobar resection for small (2 cm or less) non-small cell lung cancers // Ann. Thorac. Surg. 2011. Vol. 92. P. 1819-1823.Wolf A. S., Richards W.G., Jaklitsch M. T. et al. Lobectomyversus sublobar resection for small (2 cm or less) non-small cell lung cancers // Ann. Thorac. Surg. 2011. Vol. 92. P. 1819-1823.Yang C. F., D’Amico T.A. Thoracoscopic segmentectomy for lung cancer // Ann. Thorac. Surg. 2012. Vol. 94. P. 668-681.Yang C. F., D’Amico T.A. Thoracoscopic segmentectomy for lung cancer // Ann. Thorac. Surg. 2012. Vol. 94. P. 668-681.

The authors declare that there are no conflicts of interest present.