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Objective: To evaluate a novel precision technique for pulmonary sequestration (PS) that integrates watershed analysis and fluorescence imaging to enable function-preserving sublobectomy, overcoming the challenges of uncontrolled bleeding and unclear margins associated with traditional lobectomy.
Methods: Among 42 PS patients, 9 were selected for watershed topography-guided resection. Preoperative 3D models from CT scans simulated the ischemic territory of the aberrant artery. Intraoperatively, after ligating the artery, indocyanine green was injected. The non-perfused sequestered lung was clearly demarcated from the fluorescent healthy tissue under infrared thoracoscopy, guiding precise sublobectomy.
Results: Six of the nine patients (66.7%) successfully underwent fluorescence-guided sublobectomy. This group demonstrated excellent outcomes: short operative time (46.33±9.14 min), minimal blood loss (8.33±4.08 mL), and small resection volume (78.08±40.48 cm³). Recovery was swift with no complications. The resection volume was significantly smaller (p=0.0244) than in the 36 patients who underwent lobectomy (238.8±204.5 cm³).
Conclusions: Watershed analysis combined with intraoperative fluorescence navigation is a safe and feasible strategy for PS. It facilitates accurate localization of vessels and clear demarcation of tissue, enabling a complete yet parenchyma-sparing resection. This paradigm shift from lobectomy to sublobectomy maximizes lung function preservation and improves perioperative outcomes.
Qing Liang (1), Zihao Chen (2), Zhifei Guo (3), Wenzhao Zhong (4), Qiang Nie (5), (1) Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, (2) Guangdong Provincial People's Hospital, Guangdong, (3) Guangdong lung cancer institute, Guangzhou, NA, (4) Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangzhou, NA, (5) Guangdong Provincial People's Hospital, Guangzhou, Guangdong
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