Real Time Identification Of Sentinel Lymph Node During Vats Lobectomy Using Percutaneous Injection Of Indocyanine Green
Kook Nam Han, Hyun Koo Kim, Young Ho Choi.
Korea University Guro Hospital, Seoul, Korea, Republic of.
OBJECTIVE: Fluorescence thoracoscopic system could enable us to perform image-guided minimal invasive surgery and mediastinal lymph node dissection using Indocyanine green (ICG) installation. This video shows the potential application of fluorescence system in minimally invasive lung cancer surgery.
METHODS: A 64-years old male with NSCLC (cT1bN0, peripheral location) at right upper lobe performed thoracoscopic lobectomy and mediastinal lymph node dissection under near infrared fluorescence thoracoscopic system. We performed preoperative CT-guided hookwire localization and injected lipiodol and ICG before 1 hour from the operation.
RESULTS: . ICG fluorescence was identified well along the peribronchial and mediastinal lymphatic flow. Lobectomy and lymph node dissection was performed guided by the concept of sentinel lymph node to determine the extent of node dissection in early lung cancer. Additional subpleural lymphatic flow was identified well during the procedure which reveals possible route of skip metastasis to hilar and upper mediastinal lymphatics.
CONCLUSIONS: Near infrared fluorescence thoracoscopic system with ICG injection might be a feasible option to identify the real time lymphatic flow during VATS lobectomy in patients with early lung cancer
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