Right Upper Lobe Apical (S1) Segmentectomy Utilizing ICG Technology (Single port)

We present a case of an 83-year-old male who has been followed up for a PET avid (SUV 4.1), apical segment (S1) right upper lobe enlarging nodule (21mm in its greatest dimensions). His past medical history is significant for hypertension, deep vein thrombosis (DVT) and a previous colonic resection (2012) for a Duke A adenocarcinoma. He has a good functional status, and a CT biopsy was non-diagnostic. Lung function test were satisfactory (FEV1 93% & DLCO 91%). In thoracic surgery there had been a trend to parenchymal sparing surgery. This is evident in the transition from pneumonectomy to sleeve resection. Provided the margins are clear. The recent JCOG0802 phase III trial have demonstrated the segmentectomy achieved an overall survival advantage (HR 0.663; 95% CI 0.47-0.93) in stage 1A NSCLC, when compared to lobectomies. Moreover, a single port video assisted thoracic surgery incisions have been demonstrated to be safe and less painful for the patient. In this video of our Bristol Thoracic Surgery series and following a single port (4cm incision with a soft tissue retractor) and primary lung adenocarcinoma of frozen section, an apical (S1) segmentectmoy was performed. The camera is placed at the apex of the incision. The video describes in detail the instruments, and the steps of the procedure. We also used Indocyanine Green (ICG) Near Infra-Red fluorescent technology (5-7mg) to demarcate the intersegmental planeReferences 1. Gonzalez-Rivas D, Fieira E, Delgado M, Mendez L, Fernandez R, de la Torre M. Uniportal video-assisted thoracoscopic lobectomy. J Thorac Dis. 2013;5 Suppl 3(Suppl 3):S234-S245. doi:10.3978/j.issn.2072-1439.2013.07.30 2. Bourdages-Pageau E, Vieira A, Lacasse Y, Figueroa PU. Outcomes of Uniportal vs Multiportal Video-Assisted Thoracoscopic Lobectomy. Semin Thorac Cardiovasc Surg. 2020 Spring;32(1):145-151. doi: 10.1053/j.semtcvs.2019.05.021. Epub 2019 May 29. PMID: 31150825.