Factors Influencing the Effectiveness of Fluorescence in Determining the Intersegmental Plane During Intentional Pulmonary Segmentectomy: Results of a Prospective Study on 196 Patients.

BACKGROUND: Intentional pulmonary segmentectomy via minimally invasive surgery is now commonly used to treat early stage non-small cell lung cancers smaller than 2 cm. The main challenge of this procedure lies in identifying the intersegmental plane (ISP). Two primary methods are used: the method of inflation-deflation (MID) and indocyanine green (ICG) fluorescence. METHODS: This prospective, single-center study included 196 patients who underwent minimally invasive segmentectomy between January 2022 and December 2024. The ISP was identified using both MID and ICG injection. Patients were divided into two groups based on whether the discrepancy between the two methods was ≤ 10 mm or > 10 mm, in order to identify factors associated with discordance. RESULTS: A discrepancy > 10 mm was observed in 41.3% of cases (n = 81). Factors significantly associated with this discordance included pleuropulmonary adhesions (OR = 4.61; p = 0.032), complex segmentectomies (OR = 2.36; p = 0.027), and bronchial variations (OR = 3.72; p = 0.011). ICG visualization of the ISP was rated satisfactory or very satisfactory (score ≥ 2) in 88.8% of cases. No significant differences were observed in postoperative outcomes, complications, or resection margin quality. CONCLUSION: ICG proves to be a reliable and reproducible method for ISP visualization, though it has limitations in certain clinical situations. It remains a valuable tool, especially during the learning phase or in cases of anatomical uncertainty, and should be adapted to each patient's anatomy, the type of segmentectomy, and the surgeon's experience.