Localization of Pulmonary Nodules Using Navigation Bronchoscope and a Near-Infrared Fluorescence Thoracoscope Takashi Anayama, MD, PhD, Jimmy Qiu, MS,

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Presentation transcript:

Localization of Pulmonary Nodules Using Navigation Bronchoscope and a Near-Infrared Fluorescence Thoracoscope Takashi Anayama, MD, PhD, Jimmy Qiu, MS, Harley Chan, PhD, Takahiro Nakajima, MD, PhD, Robert Weersink, PhD, Michael Daly, MS, Judy McConnell, BS, Thomas Waddell, MD, PhD, Shaf Keshavjee, MD, MS, David Jaffray, PhD, Jonathan C. Irish, MD, MS, Kentaro Hirohashi, MD, Hironobu Wada, MD, PhD, Kazumasa Orihashi, MD, PhD, Kazuhiro Yasufuku, MD, PhD The Annals of Thoracic Surgery Volume 99, Issue 1, Pages 224-230 (January 2015) DOI: 10.1016/j.athoracsur.2014.07.050 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Indocyanine green (ICG) fluorescence in different concentrations of ICG and albumin. (A) ICG was diluted with concentration gradients from 2.5 mg/mL of stock solution in the presence of 2.0 g/dL of albumin (WL = white light photograph; FL = 830 nm fluorescence) visualized with Maestro). (B) The curve of fluorescence levels of ICG and albumin mix steeply increase when diluted to 5.0 × 10−1 (mg/mL) or lower. The logarithmic graph showed the peak fluorescence is observed at around 1.5 × 10−1 (mg/mL). (C) Either (a) ICG of 1.5 × 10−1 (mg/mL) alone or (b) the same dilution of ICG containing 2.0 g/dL of albumin was dropped on the surface of the ex vivo porcine lung tissue. (D)The fluorescent intensity of (a) and (b) was plotted. The Annals of Thoracic Surgery 2015 99, 224-230DOI: (10.1016/j.athoracsur.2014.07.050) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Tissue penetration property of indocyanine green (ICG) fluorescence in lung parenchyma. (A) The SPY scope has 300 mm of working length, 10 mm of outer diameter, and 0 degree viewing angle. (B) A 5% agar droplet containing ICG (1.5 × 10−1 mg/mL) and albumin (2.0 g/dL) was overlaid by 2.0-mm, 4.0-mm, or 12.0-mm thick deflated lung tissue and visualized by the SPY scope from 3-cm distance (WL = white light image; FL = fluorescence image). (C) A Stortz D-light system was evaluated under the same conditions. (D) Computed tomographic images of the porcine lung in both inflated and deflated states. A pulmonary nodule (agar with iopamidol) at a depth of 9.93 mm was observed at a depth of 4.84 mm in the deflated lung. The Annals of Thoracic Surgery 2015 99, 224-230DOI: (10.1016/j.athoracsur.2014.07.050) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Electromagnetic navigation bronchoscope (ENB) guided indocyanine green (ICG) injection and intraoperative thoracoscopic detection of ICG fluorescence. (A) A 0.8-mm electromagnetic (EM) sensor. (B) The sensor was integrated in the tip of a thin bronchoscope (red arrow). (1) The accessory channel, (2) light guide, and (3) eye of the bronchoscope. (C) The ENB system displays the positional information of the bronchoscope on the multidimensional computed tomographic (CT) images. (D)Three-dimensional view displays the path to the target (green line) and the position of the bronchoscope (pink line). (E) The real bronchoscopic image shows bronchoscopic needle (yellow asterisk). (F) CT images show the agar target (yellow arrow) and injected ICG/iopamidol mixture (red arrow). (G) SPY thoracoscope examination on 6 hours after ICG injection (WL = white light image; FL = fluorescence image). (H) The cross section of the lung demonstrated that the center of the pulmonary nodule (yellow asterisk) and the center of ICG fluorescence (red asterisk). The Annals of Thoracic Surgery 2015 99, 224-230DOI: (10.1016/j.athoracsur.2014.07.050) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions