Abstract:Objective To investigate the feasibility and advantages of uniportal thoracoscopy and indocyanine green combined with using EDDA to design a 3D tracheal angiography navigation for identification of intersegmental plane in pulmonary segmentectomy,and to compare with the modified inflation-deflation which is commonly used in clinic. Methods The clinical data of 100 patients who received pulmonary segmentectomy by fluorescence (indocyanine green) and uniportal thoracoscopy from April 2018 to May 2015 in Nanjing Chest Hospital were retrospectively analyzed (fluorescence group,43 males and 57 females,aging from 23 to 78).And a total of 100 patients who received pulmonary segmentectomy by modified inflation-deflation at the same period were selected as modified inflation-deflation group (48 males and 52 females,aging from 38 to 76).Preoperative CT scan data of all patients were imported into the three-dimensional intelligent interactive qualitative and quantitative image analysis system (IQQA-3D) to identify the location of nodules,and 3D reconstruction of pulmonary structures such as bronchi,arteries and veins was carried out to simulate the target segments of bronchi,arteries and veins involved in segmentectomy,and to determine their retention.The intersegmental vein and virtual intersegmental interface.In the fluorescence group,indocyanine green was injected into peripheral vein after the target pulmonary vessels and bronchus were cut off during the operation,and then the fluorescence mode of PINPOINT fluorescence thoracoscopy was opened to show the obvious intersection interface and marked by electrocoagulation.In the modified inflation-deflation group,after precisely breaking off the target segment structure,the whole lung was completely reopened,and then the unilateral ventilation was restored.With the passage of time,a clear demarcation line was formed and marked by electrocoagulation and cauterization.The clinical data of the two groups were recorded and the early clinical results were compared and analyzed. Results Except for the relatively blurred interface of the right upper apical segment of the lung in 6 cases,94% (94/100) of the fluorescence group showed clear intersegmental interface with a duration of (179.75±48.81) s,which was sufficient to complete the marking of the interface.Compared with the modified inflation-deflation group,the fluorescence group showed shorter display time［(23.59±4.47)s vs (1 026.80±318.34)s,P<0.01］ and shorter operation time［(89.28±31.57)min vs (112.80±32.96) min,P<0.01］.There was no significant difference in the width of the incision margin between the two groups［(2.53±0.52)cm vs (2.44±0.48)cm,P=0.237］,which all met the oncological requirement of ≥2 cm.There were no significant differences in bleeding volume,drainage time,hospitalization time and complication rate between the two groups (all P>0.05),and no death occurred 30 days after operation.There were no complications related to indocyanine green injection in fluorescence group. Conclusion Except for the blurred display of the right upper apical segment,the interface of all segments can be displayed quickly,accurately and clearly by fluorescence method,which can provide a safe and reliable technical guarantee for uniprotal thoracoscopic pulmonary segmentectomy.Compared with the modified inflation-deflation,it can meet the same oncological requirements and significantly shorten the operation time.It is more in line with the requirements of the concept of rapid rehabilitation and has certain clinical application value.