Yanagiya Masahiro, Sato Masaaki, Ijiri Naohiro, Kobayashi Kimihiko, Nagano Masaaki, Konoeda Chihiro, Kitano Kentaro, Nakajima Jun
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
J Thorac Dis. 2022 Apr;14(4):1061-1069. doi: 10.21037/jtd-21-1829.
Virtual-assisted lung mapping (VAL-MAP) is a preoperative bronchoscopic multispot dye-marking procedure to facilitate sublobar lung resection for unidentifiable lung nodules. To increase detectable markings, we performed VAL-MAP using dual staining (VAL-MAP DS) with indocyanine green (ICG) and indigo carmine. This study was designed to evaluate the efficacy and safety of the modified technique.
We retrospectively reviewed the records of patients who underwent VAL-MAP DS. Twenty patients with 27 lesions underwent 72 VAL-MAP DS markings. We investigated the overall detectable marking rate, visible marking rate, successful resection rate, and complications.
The overall detectable marking rate, thanks to both ICG and indigo carmine, tended to be higher than the indigo carmine visible marking rate (95.7% 85.5%, P=0.08). The successful resection rate with sufficient margins was 92.0%. There were no adverse events related to the use of ICG. ICG markings of the lungs of patients with a history of smoking more than 50 pack-years tended to be visible, but the staining was too extensive compared with the staining in patients who smoked less or not at all (58.8% 0.0%, P<0.001).
VAL-MAP DS is likely be efficacious and safe in enhancing the detectability of markings. This bronchoscopic technique should be considered as one of the optimal preoperative marking methods in thoracic surgery.
虚拟辅助肺绘图（VAL-MAP）是一种术前支气管镜多点染料标记程序，用于促进难以识别的肺结节的亚肺叶切除。为了增加可检测的标记，我们使用吲哚菁绿（ICG）和靛胭脂进行双重染色（VAL-MAP DS）来进行VAL-MAP。本研究旨在评估改良技术的有效性和安全性。
我们回顾性分析了接受VAL-MAP DS的患者的记录。20例患者的27个病灶接受了72次VAL-MAP DS标记。我们调查了总体可检测标记率、可见标记率、成功切除率和并发症。
由于ICG和靛胭脂的共同作用，总体可检测标记率往往高于靛胭脂可见标记率（95.7%对85.5%，P=0.08）。切缘足够的成功切除率为92.0%。没有与使用ICG相关的不良事件。有超过50包年吸烟史的患者肺部的ICG标记往往可见，但与吸烟较少或不吸烟的患者相比，染色范围过大（58.8%对0.0%，P<0.001）。
VAL-MAP DS在提高标记的可检测性方面可能是有效和安全的。这种支气管镜技术应被视为胸外科最佳术前标记方法之一。
