Dual Techniques for Identifying Intersegmental Planes Using Indocyanine Green and Virtual-Assisted Lung Mapping in Robotic Segmentectomy

Useful methods for identifying the intersegmental plane during robot-assisted thoracoscopic surgery (RATS) remain unclear. This study aimed to investigate techniques for identifying the intersegmental plane during robotic segmentectomy. Patients who underwent robotic segmentectomy between January 2017 and January 2023 were enrolled. We retrospectively evaluated methods for identifying the intersegmental plane by using selective segmental inflation-deflation RATS and intravenous indocyanine green (ICG) with or without virtual-assisted lung mapping (VAL-MAP) RATS. Patients’ characteristics and perioperative outcomes were compared among the groups. Among the 497 patients who underwent robotic lung resection, this study enrolled 112 patients (23%) who underwent robotic segmentectomy. Fifty-three patients (47%) underwent selective segmental inflation-deflation RATS, and 59 patients (53%) received ICG injection with or without VAL-MAP RATS. Clinical factors, surgical findings, and postoperative complications were similar among all groups. Complex segmentectomy was performed more frequently in the ICG with or without VAL-MAP RATS group than in the selective segmental inflation-deflation RATS group (35 patients vs 12 patients). Dual techniques involving ICG injection and VAL-MAP marking robotic complex segmentectomy were performed for tumors located close to the intersegmental plane in 4 patients. In these patients, the distance to the surgical margin was greater than the tumor diameter. No complications were caused by ICG injection or VAL-MAP markings. Dual techniques for identifying intersegmental planes using ICG and preoperative VAL-MAP markings are safe and useful for robotic lung segmentectomy.