A method to identify pulmonary intersegmental planes with intravenous vitamin B 2 injection
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ORIGINAL ARTICLE
A method to identify pulmonary intersegmental planes with intravenous vitamin B 2 injection Daisuke Saito1 · Isao Matsumoto1 · Ryuichi Waseda2 · Keisuke Tatemichi1 · Yusuke Tanaka1 · Shuhei Yoshida1 · Munehisa Takata1 · Masaya Tamura1 · Hirofumi Takemura1 Received: 1 May 2020 / Accepted: 18 August 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose The present study investigated whether the pulmonary intersegmental planes could be identified with the intravenous injection of vitamin B2 using a fluorescent camera and whether this method can be used instead of the inflation–deflation technique or the intravenous indocyanine green (ICG) method. Methods In experiment 1, the vitamin B2 was intravenously injected to visualize the pulmonary intersegmental plane and perform segmentectomy, and the visualized pulmonary intersegmental line was then compared to the inflation–deflation line in six pigs. In experiment 2, using six pigs, the fluorescent area and duration of fluorescence were compared after the intravenous injection of vitamin B2 and ICG in the same animals. Results In all animals in experiment 1, it was possible to clearly detect yellow–green fluorescence in the lung, in segments other than the one intended for resection, for at least 60 min. Moreover, the line visualized with vitamin B 2 fluorescence matched the inflation–deflation line in all animals. In experiment 2, the area of vitamin B2 fluorescence corresponded to the area of ICG fluorescence in each animal. Conclusions The visualization of fluorescence after the intravenous injection of vitamin B 2 using a fluorescent camera was a simple, safe, and accurate method for detecting intersegmental planes in a pig model. This method can be an alternative to the inflation–deflation technique and the intravenous ICG method. Keywords Vitamin B2 · Lung segmentectomy · Intersegmental plane · Fluorescence · Non-small cell lung cancer
Introduction Precise identification of the pulmonary intersegmental plane is needed for optimal segmentectomy. An optimal method to identify the pulmonary intersegmental planes would accurately and clearly delineate the pulmonary intersegmental plane both at the lung surface and in the lung parenchyma, regardless of the surgical approach or underlying pulmonary conditions.
* Isao Matsumoto [email protected] 1
Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University, 13‑1, Takaramachi, Kanazawa, Ishikawa 920‑8641, Japan
Department of General Thoracic, Breast and Pediatric Surgery, Faculty of Medicine, Fukuoka University, 7‑45‑1, Nanakuma, Jonan, Fukuoka 814‑0180, Japan
2
Various methods to identify pulmonary intersegmental planes have been reported [1]. Classically, many surgeons have used the intersegmental pulmonary vein as a guide [2]. In addition, surgeons currently use the “inflation–deflation technique,” a method that is commonly used to identify the pulmonary intersegmental planes by creating an inflation–deflation line on the visceral pleura [3].
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