Chen Yongjiang, He Jiaxi, Wang Chudong, Li Shuben
Department of Thoracic Surgery, Guangzhou Medical University 1st Affiliated Hospital, Guangzhou, China.
Transl Cancer Res. 2023 Oct 31;12(10):2946-2951. doi: 10.21037/tcr-23-729. Epub 2023 Oct 20.
Extensive and dense pleural adhesion is a serious challenge in video-assisted thoracoscopic surgery (VATS), in which identification of vessels and their anatomical spaces is difficult. Once critical vessel is damaged while dissecting adhesion in VATS, leading to fatal hemorrhage, the surgeon will have to switch to thoracotomy. This is the first report of a case in which intraoperative indocyanine green (ICG) fluorescence imaging was used to identify critical vessels in severe pleural adhesions in uniportal VATS.
The patient (67-year-old male) with an 8-year history of tuberculosis and severe mixed ventilation dysfunction underwent a standardized wedge resection due to chest computed tomography (CT) scan that revealed a 2.6-cm nodule in the right upper lung. Intraoperatively, the superior vena cava and azygos vein were successfully identified and safely dissected using ICG fluorescence imaging in the presence of extensive and dense pleural adhesions. The chest drainage tube was removed on postoperative day (POD) 3, and patient was released from hospital on POD 5. The patient recovered well and no complication was observed in the follow-up.
The ICG fluorescence imaging is used to illustrate the vessels and help to dissect them safely, which is a feasible, visualizable, and user-friendly method in severe pleural adhesions in uniportal VATS.
广泛而致密的胸膜粘连是电视辅助胸腔镜手术（VATS）中的一项严峻挑战，在此类手术中难以识别血管及其解剖间隙。在VATS中进行粘连分离时，一旦关键血管受损并导致致命性出血，外科医生将不得不转为开胸手术。本文首次报道了在单孔VATS中使用术中吲哚菁绿（ICG）荧光成像来识别严重胸膜粘连中的关键血管的病例。
该患者为67岁男性，有8年肺结核病史且存在严重混合性通气功能障碍，因胸部计算机断层扫描（CT）显示右上肺有一个2.6厘米的结节而接受了标准化楔形切除术。术中，在存在广泛而致密的胸膜粘连的情况下，使用ICG荧光成像成功识别了上腔静脉和奇静脉，并安全地进行了分离。术后第3天拔除胸腔引流管，术后第5天患者出院。患者恢复良好，随访期间未观察到并发症。
ICG荧光成像用于显示血管并有助于安全地进行分离，对于单孔VATS中的严重胸膜粘连而言，这是一种可行、可视化且对用户友好的方法。
