5．切除領域縮小による手術低侵襲化のための工夫（区域間の同定など）−血管から

The maintenance of a good surgical view is mandatory in video-assisted thoracoscopic surgery （VATS）. For routine segmentectomy, it is necessary to re-inflate the lung in order to identify the intersegmental borders. However, such re-inflation can occasionally obstruct the surgical view and can lead to prolongation of operation time, particularly in the context of VATS. Infrared thoracoscopy（ IRT） with indocyanine green （ICG） is a new method of evaluating lung perfusion. There are 2 methods in IRT. One is based on ICG absorption, and the other is based on ICG fluorescence. In our experience, both of them were useful for identification of segmental borders. However, the former method was superior for the clarity of images. No complications attributable to IRT with ICG were observed. IRT with ICG is based on blood flow rather than on ventilation and can thus achieve anatomical segmentectomy without lung re-inflation. This method will be especially useful for VATS segmentectomy.