| Principles |
Ventilate the lug after clamping or cutting the target bronchus |
Inflate the segment through the target bronchus by bronchoscopic jet ventilation or direct intubation |
|
Intravenously inject ICG after clamping or cutting the target pulmonary artery (target segment does not fluoresce) |
Stain the segment through the target bronchus by dye injection through a bronchoscope or directly through the endotracheal tube |
Multiple dye marks made at the corner of the target segment or adjacent segment, or beyond the segment, to obtain resection margins |
| Timing |
Intraoperative |
Intraoperative |
|
Intraoperative |
Preoperative/intraoperative |
Preoperative |
| Advantages |
Very easy and quick |
Relatively easy |
|
Easy and quick |
Dye remains longer than with intravenous injection (lasts the duration of the operation) |
Preoperative confirmation made regarding the relationship between the dye marks and the tumor, to secure margins (reproducibility) |
| No preparation is needed |
Less interference with thoracoscopic view |
|
Repeatable (fluorescence remains for a few minutes) |
May not need infrared thoracoscopy (fluorescence) |
|
|
May help to obtain better resection margins |
|
Demark the lung parenchyma around the hilum |
|
| Disadvantages |
Interferes with thoracoscopic view |
Some preparation needed |
|
Collateral circulation and emphysematous lung may be misleading |
Airway secretions and collateral ventilation may obscure intersegmental lines |
Requires preoperative preparation |
|
Needle-mediated injection is prohibited |
|
Correct identification of pulmonary artery is mandatory |
|
Requires basic instruments and an available facility (e.g., with fluoroscopy) |
| Does not demark true intersegmental planes |
| Intersegmental lines could be obscured because of collateral ventilation or airway secretions |
|
Infrared thoracoscopy is required |
– |
| Once electrocautery is used to develop the intersegmental planes, the inflated lung deflates and demarcation is obscured |
|
