A new LigaSure technique for the formation of segmental plane by intravenous indocyanine green fluorescence during thoracoscopic anatomical segmentectomy.

Kuroda, Hiroaki; Dejima, Hitoshi; Mizumo, Tetsuya; Sakakura, Noriaki; Sakao, Yukinori

BACKGROUND The purpose of this study was to present a new approach to the formation of a segmental plane by LigaSure (Covidien, Mansfield, MA, USA) with indocyanine green (ICG) fluorescence system during thoracoscopic segmentectomy. METHODS This was a consecutive study that compared 12 patients who underwent a new LigaSure technique (LT) for segmental plane formation during thoracoscopic anatomical segmentectomy with 38 patients who underwent conventional methods using the staple technique (ST). Eleven patients were followed up more than 3 months after discharge. RESULTS The mean age of the patients was 66 years in the LT group and 67 years in ST. The mean duration for the formation of segmental plane and the mean number of staples was 22.8 min and 1.8 per surgery, respectively, in the LT group; and 16.2 min and 3.4 per surgery, respectively, in ST. No patient had a prolonged air leak (PAL) of more than 7 days. Minor air leak was identified early in two and was delayed in one. Two-thirds of patients with early minor air leak had low index of prolonged air leak (IPAL) score. There was no air leak in the patients with high IPAL score. Eventually, we deduced that the cause of the minor air leak was a technical problem. CONCLUSIONS In the formation of segmental plane during thoracoscopic segmentectomy, a combination of ICG fluorescence and LigaSure may be beneficial for patients. As a new operative instrument, LT constitutes, in our opinion, a feasible and easy alternative to other thoracoscopic techniques.