Near-Infrared Fluorescence Imaging Can Help Identify the Contralateral Phrenic Nerve During Robotic Thymectomy
Near-Infrared Fluorescence Imaging Can Help Identify the Contralateral Phrenic Nerve During Robotic Thymectomy
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DOI：
10.1016/j.athoracsur.2012.04.119
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发表时间：
2012-08-01
影响因子：
4.6
通讯作者：
Farivar, Alexander S.
中科院分区：
文献类型：
--
作者：
Wagner, Oliver J.;Louie, Brian E.;Farivar, Alexander S.
目的。单侧机器人胸腺切除术越来越受欢迎。确定对侧膈神经是实现最大胸腺组织切除的关键限制。我们评估了davincii - si机器人（Intuitive Surgical Inc, Sunnyvale， CA）荧光成像识别对侧心包神经血管束（PNB）的可行性和技术。10例患者行单侧机器人右侧胸腺切除术。胸腺及其两极活动。注射吲哚菁绿并荧光识别四个不同视角下的左侧PNB，以评估始终积极识别PNB的视图。无吲哚菁绿并发症及膈神经损伤。80%的患者在左胸膜面可见对侧PNB，很少从纵隔面可见，并且从未在主动脉肺窗远端可见。在右侧机器人胸腺切除术中，荧光成像通过对心包血管进行荧光扫描，有助于识别对侧膈神经。从左胸膜上看最清楚。该技术有潜力通过单侧入路最大限度地切除胸腺组织，同时减少手术时间和神经损伤。（Ann Thorac surgery 2012;94:622-5） (c) 2012年由胸外科医生协会批准
Purpose. Unilateral robotic thymectomy is gaining popularity. Identifying the contralateral phrenic nerve is a key limitation to achieving maximal thymic tissue resection. We evaluated the feasibility and technique of fluorescence imaging on the daVinci-Si robot (Intuitive Surgical Inc, Sunnyvale, CA) to identify the contralateral periocardiophrenic neurovascular bundle (PNB).Description. A unilateral right robotic thymectomy was performed in 10 patients. The thymus and its poles were mobilized. Indocyanine green was injected and fluoresced to identify the left PNB in four different viewing angles to assess the view that consistently positively identified the PNB.Evaluation. No complications from indocyanine green or injuries to the phrenic nerve occurred. The contralateral PNB was visualized in 80% of patients from a left pleural view, infrequently from a mediastinal view, and never distal to the aortopulmonary window.Conclusions. During right robotic thymectomy, fluorescence imaging facilitates identification of the contralateral phrenic nerve by fluorescing the pericardiophrenic vessels. It is best visualized from a left pleural view. This technology has the potential to maximize thymic tissue resection with a unilateral approach while reducing operative time and nerve injury. (Ann Thorac Surg 2012;94:622-5) (c) 2012 by The Society of Thoracic Surgeons