Intraoperative real-time determination of intersegmental plane with hyperspectral imaging during VATS pulmonary segmentectomies: a case study

Background In patients with early stage lung cancer<2cm anatomical segmentectomy is recommended in the national and international guidelines. Declination of the intersegmental plane is one of the intraoperative challenges. Hyperspectral imaging (HSI) enables a non-invasive, real-time evaluation of tissue perfusion. In this pilot study, we evaluated the feasibility of HSI Imaging for the identification of the intersegmental plane during VATS segmentectomies.

Methods & Materials A case pilot study was conducted in patients with early-stage lung cancer. Measuring tissue oxygenation (StO₂; upper tissue perfusion), organ hemoglobin index (OHI), near-infrared index (NIR; deeper tissue perfusion) and tissue water index (TWI), the HSI measurements were carried during VATS segmentectomies. Following dissection of the corresponding segmental artery, vein, and bronchus, HSI measurements was taken with the Tivita Mini camera (Diaspective Vision, Am Salzhaff, Germany) after resection the venous and arterial vessels of the segment(s). Afterwards, the intersegmental plane was visualized by near-infrared fluorescence imaging (Indocyanin green; ICG) using a fluorescence imaging camera (IMAGE1 S Rubina, Karl Storz AG, Tuttlingen, Germany). After surgery, HSI intersegmental plane visualization was compared to the infrared fluorescence imaging.

Results In 5 cases the intersegmental plane identification was conducted by HSI and ICG. The NIR visualization revealed a similar intersegmental plane like near-infrared fluorescence imaging. In contrast, the StO₂ it is more influenced by the camera focus and the distance between the camera tip and the assessed tissue. There were no differences of OHI and TWI between the resected segment(s) and the rest of the pulmonary tissue.

Conclusion Hyperspectral Imaging enables a non-invasive, real-time intraoperative assessment of the intersegmental plane. The NIR values are currently the most promising parameter for the intersegmental plane visualization. These results provide the basis for further evaluation of Hyperspectral Imaging for the intersegmental plane declination during pulmonary segmentectomies in a prospective study.

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Artikel online veröffentlicht:
13. August 2024