Three-dimensional computed tomography and indocyanine green-guided technique for pulmonary sequestration surgery
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Three‑dimensional computed tomography and indocyanine green‑guided technique for pulmonary sequestration surgery Shunichiro Matsuoka1 · Takashi Eguchi1 · Tetsu Takeda1 · Kentaro Miura1 · Kazutoshi Hamanaka1 · Kimihiro Shimizu1 Received: 5 August 2020 / Accepted: 5 October 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Patients with pulmonary sequestration are at risk of life-threatening bleeding during lung resection. To perform safe and adequate lung resection in patients with pulmonary sequestration, we utilized the following combination of techniques: (1) three-dimensional computed tomographic (3D-CT) imaging for preoperative planning and intraoperative identification of blood vessels, including aberrant arteries, and (2) intraoperative intravenous administration of indocyanine green (ICG). We describe our surgical technique through three cases who underwent lung resection for pulmonary sequestration using 3D-CT and fluorescence navigation with ICG. Intraoperative identification and division of the aberrant arteries, draining veins, and resection margins of the lungs were successfully completed. Keywords Pulmonary sequestration · Indocyanine green · Three-dimensional computed tomography
Introduction Pulmonary sequestration is a rare malformation characterized by nonfunctional (sequestrated) lung tissue with an abnormal tracheobronchial tree supplied by aberrant systemic arteries [1, 2]. Pulmonary sequestration patients are at risk of hemoptysis, respiratory infections, and intrapulmonary hemorrhage. The mainstay of treatment is surgical resection of the sequestrated lung and shutting off aberrant feeding arteries [3, 4]. To avoid life-threatening hemorrhage and imprecise pulmonary resection, accurate intraoperative identification of the aberrant arteries and precise margins of the sequestrated lung is paramount. Therefore, we utilized a combination of two imaging techniques: (1) three-dimensional computed tomographic (3D-CT) imaging for preoperative planning and intraoperative identification of the blood vessels, and (2) intraoperative intravenous administration of indocyanine Shunichiro Matsuoka and Takashi Eguchi contributed equally. * Kimihiro Shimizu [email protected] 1
Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3‑1‑1 Asahi Matsumoto, Nagano 390‑8621, Japan
green (ICG) for demarcating the sequestrated lung. We report three cases who successfully underwent lung resection for pulmonary sequestration using 3D-CT and ICG.
Techniques All contrast-enhanced 3D-CT examinations (Revolution CT, GE Healthcare, US) were performed at our institute using 0.63-mm-thick full-resolution scans. The images were constructed using a DICOM data workstation (Ziostation2, Ziosoft, Japan). Preoperatively, the aberrant arteries (including origins and branches) of the pulmonary artery (PA), pulmonary vein (PV), and bronchus of the affected lobe were identified using 3D-CT. We isolated the draining vein from the sequestrated lung, but
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