Near-Infrared Fluorescence Guided Robotic Pulmonary Segmentectomy for Early Stage Lung Cancer: Analysis of Accuracy and Added Value
Lungs are made up of individual lobes. When a lung cancer tumour is detected in one of these
lobes, surgeons typically perform a Lobectomy. A Lobectomy is the surgery most commonly done
to treat early-stage lung cancer and requires removal of an entire lobe of the lung, which
removes a large amount of lung tissue For patients with small tumours saving as much healthy
lung tissue as possible is important. Each lobe of the lung has smaller sections called
segments. When a lung cancer is in one of these segments, it is possible to remove that
segment, without removing the entire lobe. This surgery is called a segmentectomy. Compared
to a lobectomy, a segmentectomy saves a larger amount of healthy lung tissue.
With the advances in screening technology for lung cancer tumours, an increasing amount of
very small lung cancer tumours are being found, and the demand for segmentectomy is
increasing. A segmentectomy is a hard surgery to perform robotically because it is difficult
to view the tissue lines that separate each segment within the lobe. As a result, it is
difficult for the surgeon to see exactly which pieces of tissue should be removed. Because
of these challenges, many patients having robotic surgery will have a lobectomy, even if a
full lobectomy is not needed.
Near-Infrared Fluorescence (NIF) using indocyanine green (ICG) fluorescent dye is a recent
advancement in the robotic platform of robotic surgery. The surgeon will view the CT scan to
determine which segment the tumour is located in. Once identified, the surgeon will isolate
the segment by cutting off the blood supply to that segment. Then ICG will be injected into
a vein. It is expected that the entire lung, except the isolated segment, which will remain
'dark' as it was isolated from blood supply, will fluoresce, giving off a green hue when
viewed with the da Vinci Firefly camera. The surgeon will identify 'dark' segment, and will
remove it. A pathologist will examine the excised tissue to ensure that the tumour was
removed in its entirety. Once confirmed, the surgeon will end the procedure. If the
pathologist determines that the segment removed did not contain the entire tumour, then the
surgeon will perform a routine lobectomy. This ensures patient safety and confirms that all
participants will have the entire tumour removed from their lung.
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