Comparison of watershed analysis with indocyanine green fluorescence staining and modified inflation-deflation method in single-port thoracoscopic complex pulmonary segmentectomy

Background: The increasing utilization of computed tomography (CT) scans has significantly elevated the detection rate of pulmonary nodules. Pulmonary segmentectomy has become the preferred surgical technique for peripheral non-small cell lung cancer (NSCLC) measuring 2 cm or smaller. Various methods for identifying the intersegmental planes (ISPs) are currently employed. This study aims to compare the short-term clinical safety and efficacy of the watershed analysis with indocyanine green (ICG) fluorescence staining to the modified inflation-deflation method in single-port thoracoscopic complex pulmonary segmentectomy.

Methods: This retrospective study was conducted on patients who underwent single-port thoracoscopic complex pulmonary segmentectomy at The First Affiliated Hospital of Soochow University between January 2023 and December 2023. One cohort received treatment with the watershed analysis with ICG fluorescence staining, while the other cohort was treated with the modified inflation-deflation method. The study evaluated intraoperative and postoperative conditions, as well as the short-term impact on postoperative pulmonary function in both groups.

Results: The watershed analysis with ICG fluorescence staining group demonstrated less operating time (P<0.001), shorter ISPs visualization time (P<0.001), and reduced intraoperative blood loss (P<0.001). Postoperatively, 8 patients (16%) in this group experienced air leakage, compared to 20 patients (39%) in the modified inflation-deflation method group, indicating significant differences between the groups (P=0.009). Additionally, the watershed analysis with ICG fluorescence staining group had shorter postoperative drainage tube duration (P<0.001), shorter postoperative hospitalization (P<0.001), and less postoperative pleural effusion volume (P<0.001). There was no disparity observed in pulmonary function decline at three months after the surgery between the two cohorts.

Conclusions: The watershed analysis with ICG fluorescence staining is associated with less operating time, fewer postoperative complications, and a lower risk of postoperative air leakage in complex pulmonary segmentectomy. The impact on pulmonary function was comparable to the traditional method. These findings suggest that the watershed analysis with ICG fluorescence staining is a more promising, safe, and effective approach for complex pulmonary segmentectomy.