Impact of near-infrared angiography on the quality of anatomical resection during video-assisted thoracic surgery segmentectomy

Background: The aim of the present study was to assess the impact of near-infrared angiography in guiding intraoperatively sublobar anatomical resection by video-assisted thoracic surgery (VATS). Methods: We retrospectively analyzed data from 67 patients who underwent segmentectomy by VATS from November 2014 to November 2017 at the University Hospitals of Geneva, Switzerland. The need to modify arterial or parenchymal resection based on intraoperative near-infrared imaging was considered the primary study outcome. Results: A total of 67 patients (28 men, 39 women, mean age 66 +/- 10 years) underwent anatomical pulmonary segmentectomy by VATS. Histological analysis revealed a primary lung tumor in 59 patients. The mean +/- standard deviation (SD) operation time was 154 +/- 51 minutes. Identification of the intersegmental plane (ISP) with near-infrared angiography was achieved in 88% of patients and led to modification of the resection during segmentectomy in 7 patients (10%), avoiding inappropriate resection; 2 patients had distant tumor recurrences (3%). Conclusions: Near-infrared angiography during VATS segmentectomy is effective for identifying ISPs, with respect to the oncological margins, as well as for correcting the anatomical resection.