Synapse 3D With Intravascular Indocyanine Green

NCT03953144 | Recruiting Phase 1 FDA Drug FDA Device

• 1 other identifier: VISION10042019
• Study Type: interventional
• Target: 32
• Locations: 1 country
• Sites: 1

Brief Summary

With the advent of CT screening for lung cancer, an increasing number of NSCLCs are being detected at very early stages, and the demand for pulmonary segmentectomy is rising rapidly. As such, there is a need to develop new surgical techniques to facilitate minimally invasive pulmonary segmentectomy, as segmentectomy may provide a number of significant advantages over lobectomy for patients presenting with early-stage lung cancer, or for patients unable to undergo a full lobectomy due to existing comorbidities. This study will provide the first case series using preoperative 3D anatomical planning (Synapse 3D) added to ICG and NIF-guided robotic segmentectomy to date and will be the first reported use of Synapse 3D-guided targeted pulmonary segmental resection in Canada. As lung cancer is the most frequently fatal cancer in North America, many thousands of patients will be able to benefit from this operation every year.

Conditions

Non-small Cell Lung Cancer; Primary Neoplasm

Keywords

Segmentectomy; Lung Cancer; Robotic Surgery; 3D Modelling; CT Imaging; Near-Infrared Fluorescence; IC-GREEN; Surgical Planning; Indocyanine Green; Early-Stage Lung Cancer; Surgical Mapping; Lung Preservation

Outcome Measures

Primary Outcomes (2)

• Segmental Resection Conversion Rate

  Rate of conversions to lobectomy will be measured by collecting the proportion of conversions to lobectomy.

  1 year

• Number of Participants with Post Operative Complications

  Post operative complications will be reported and measured using the Ottawa Thoracic Morbidity and Mortality Classification of (a) Adverse reactions to ICG dye at the time of surgery and (b) Perioperative complications through study completion.

  1 year

Secondary Outcomes (7)

• Anatomical Accuracy of the 3D Lung Model

  1 year

• Surgeon Confidence

  1 year

• Operation Time

  1 year

• Conversion to Thoracotomy

  1 year

• Chest Tube Duration

  1 year

Study Arms (1)

Synapse 3D Lung Modelling + IC-GREEN Segmentectomy

EXPERIMENTAL

Patients within this arm will undergo a high-resolution CT scan of the chest, which is required by Synapse 3D to create accurate 3D virtual model reconstructions. At the start of the operation, the 3D virtual model of the segmental pulmonary anatomy will be displayed on the da Vinci Robotic platform for operative planning. The model will be used as a guide to determine which vessels are involved in the segment and need to be removed. The surgeon will ligate the pulmonary vein and pulmonary artery of the broncho-pulmonary segment with the lung cancer nodule, isolating it from any blood supply, and mark the proposed segmental planes based on the 3D model. ICG will be prepared as a sterile solution (2.5 mg/10mL) for injection. After vascular ligation, an 8 mL bolus of ICG solution will be injected into the peripheral vein catheter, followed by a 10 mL saline solution bolus

Device: Synapse 3D Lung Modelling; Drug: IC-Green (ICG)

Interventions

Synapse 3D Lung Modelling DEVICE

The 3D virtual models provided by Synapse 3D will be made by experts in medical image analysis using the high-resolution CT scans. Patients will have 3D virtual reconstructions of their pulmonary anatomy with the target lesion created pre-operatively.

Synapse 3D Lung Modelling + IC-GREEN Segmentectomy

IC-Green (ICG) DRUG

ICG will be prepared as a sterile solution (2.5 mg/10mL) for injection. After vascular ligation, a 6 to 8mL bolus of ICG solution will be injected into the peripheral vein catheter, followed by a 10mL saline solution bolus. The Firefly camera will then be used for the NIF imaging. It is expected that the entire lung, except the segment which was previously isolated from blood supply, will fluoresce within 30-40 seconds, exhibiting a green hue. The surgeon will perform the pulmonary resection and the resected 'dark' lung segment will be immediately evaluated by a pathologist, depending on the pathologist findings the operation may be concluded or the patient will receive a pulmonary lobectomy.

Also known as: Indocyanine Green

Synapse 3D Lung Modelling + IC-GREEN Segmentectomy

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Tumour size \<3 cm
• Clinical Stage 1 Non-Small Cell Lung Cancer (NSCLC)
• CT-imaging confirming that the tumour is confined to one broncho-pulmonary segment, rendering the patient a candidate for segmental resection.

You may not qualify if:

• Hypersensitivity or allergy to ICG, sodium iodide, or iodine
• Women who are currently pregnant or breastfeeding; or women of childbearing potential who are not currently taking adequate birth control.
• Patients with clinical evidence of N1 or N2 disease on preoperative imaging
• Pulmonary Function tests demonstrating Forced Expiratory Volume in 1s (FEV1) or diffusion capacity of the lung for carbon monoxide (DLCO) less than or equal to 30% of predicted.

Sponsors & Collaborators

• St. Joseph's Healthcare Hamilton: lead

Study Sites (1)

St. Josephs Healthcare Hamilton

Hamilton, Ontario, L8N 4A6, Canada

RECRUITING

Related Publications (9)

• Landreneau RJ, Sugarbaker DJ, Mack MJ, Hazelrigg SR, Luketich JD, Fetterman L, Liptay MJ, Bartley S, Boley TM, Keenan RJ, Ferson PF, Weyant RJ, Naunheim KS. Wedge resection versus lobectomy for stage I (T1 N0 M0) non-small-cell lung cancer. J Thorac Cardiovasc Surg. 1997 Apr;113(4):691-8; discussion 698-700. doi: 10.1016/S0022-5223(97)70226-5.

  PMID: 9104978 BACKGROUND

• Zhao X, Qian L, Luo Q, Huang J. Segmentectomy as a safe and equally effective surgical option under complete video-assisted thoracic surgery for patients of stage I non-small cell lung cancer. J Cardiothorac Surg. 2013 Apr 29;8:116. doi: 10.1186/1749-8090-8-116.

  PMID: 23628209 BACKGROUND

• Bedetti B, Bertolaccini L, Rocco R, Schmidt J, Solli P, Scarci M. Segmentectomy versus lobectomy for stage I non-small cell lung cancer: a systematic review and meta-analysis. J Thorac Dis. 2017 Jun;9(6):1615-1623. doi: 10.21037/jtd.2017.05.79.

  PMID: 28740676 BACKGROUND

• Gossot D, Seguin-Givelet A. Anatomical variations and pitfalls to know during thoracoscopic segmentectomies. J Thorac Dis. 2018 Apr;10(Suppl 10):S1134-S1144. doi: 10.21037/jtd.2017.11.87.

  PMID: 29785286 BACKGROUND

• Mehta M, Patel YS, Yasufuku K, Waddell TK, Shargall Y, Fahim C, Hanna WC. Near-infrared mapping with indocyanine green is associated with an increase in oncological margin length in minimally invasive segmentectomy. J Thorac Cardiovasc Surg. 2019 May;157(5):2029-2035. doi: 10.1016/j.jtcvs.2018.12.099. Epub 2019 Jan 21.

  PMID: 30803778 BACKGROUND

• Fukuhara K, Akashi A, Nakane S, Tomita E. Preoperative assessment of the pulmonary artery by three-dimensional computed tomography before video-assisted thoracic surgery lobectomy. Eur J Cardiothorac Surg. 2008 Oct;34(4):875-7. doi: 10.1016/j.ejcts.2008.07.014. Epub 2008 Aug 15.

  PMID: 18703345 BACKGROUND

• Baste JM, Soldea V, Lachkar S, Rinieri P, Sarsam M, Bottet B, Peillon C. Development of a precision multimodal surgical navigation system for lung robotic segmentectomy. J Thorac Dis. 2018 Apr;10(Suppl 10):S1195-S1204. doi: 10.21037/jtd.2018.01.32.

  PMID: 29785294 BACKGROUND

• Ivanovic J, Al-Hussaini A, Al-Shehab D, Threader J, Villeneuve PJ, Ramsay T, Maziak DE, Gilbert S, Shamji FM, Sundaresan RS, Seely AJ. Evaluating the reliability and reproducibility of the Ottawa Thoracic Morbidity and Mortality classification system. Ann Thorac Surg. 2011 Feb;91(2):387-93. doi: 10.1016/j.athoracsur.2010.10.035.

  PMID: 21256276 BACKGROUND

• Pardolesi A, Veronesi G, Solli P, Spaggiari L. Use of indocyanine green to facilitate intersegmental plane identification during robotic anatomic segmentectomy. J Thorac Cardiovasc Surg. 2014 Aug;148(2):737-8. doi: 10.1016/j.jtcvs.2014.03.001. Epub 2014 Mar 5. No abstract available.

  PMID: 24680390 BACKGROUND

MeSH Terms

Conditions

Carcinoma, Non-Small-Cell Lung; Lung Neoplasms

Interventions

Indocyanine Green

Condition Hierarchy (Ancestors)

Carcinoma, Bronchogenic; Bronchial Neoplasms; Respiratory Tract Neoplasms; Thoracic Neoplasms; Neoplasms by Site; Neoplasms; Lung Diseases; Respiratory Tract Diseases

Intervention Hierarchy (Ancestors)

Indoles; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Heterocyclic Compounds

Study Officials

• Waël C Hanna, MDCM, MBA, FRCSC

  St. Joseph's Healthcare Hamilton / McMaster University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Peter R. A. Malik, BHSc (Honours)

CONTACT

905-522-1155; malikpr@mcmaster.ca

Yogita S Patel, BSc

CONTACT

905-522-1155; patelys@mcmaster.ca

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NA
• Masking: NONE
• Masking Details: Open Label, single-arm feasibility trial.
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Director, Research Program, Boris Family Centre for Robotic Surgery

Model Details: This study is a single centre, prospective clinical trial evaluating the safety and feasibility of adding 3D anatomical reconstructions and real-time intraoperative planning using Synapse 3D software added to NIF-guided targeted segmental resection. It is anticipated that 32 participants will be enrolled within a 1-year period. Enrollment will take place at St. Joseph's Healthcare Hamilton. All patients enrolled will be evaluated until their first scheduled follow-up appointment (within 30 days post-surgery).

Study Record Dates

• First Submitted: April 30, 2019
• First Posted: May 16, 2019
• Study Start: December 1, 2022
• Primary Completion (Estimated): September 30, 2026
• Study Completion (Estimated): December 31, 2026
• Last Updated: February 2, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)