Chinese expert consensus on the clinical application and evaluation of the high-end three-dimension fluorescence medical thoracoscope in thoracic surgery (version 2025)_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 Thoracic Surgery Branch of China International Exchange and Promotive Association for Medical and Health Care , Non-Small Cell Lung Cancer Professional Committee of the China Anti-Cancer Association , Chest Tumors Minimally Invasive Diagnosis and Treatment Society of China Medical Education Association , Thoracic Surgeon Branch of Zhejiang Medical Doctors Association

Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Clinical Evaluation Technology for Medical Device of Zhejiang Province, Hangzhou, 310003, P. R. China;

Corresponding author：

Thoracic Surgery Branch of China International Exchange and Promotive Association for Medical and Health Care, Email: dr_hujian@zju.edu.cn

Keywords：

Three-dimension fluorescence; medical endoscope; thoracic surgery; clinical application and evaluation; expert consensus

DOI：

10.7507/1007-4848.202503052

Video：

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This consensus aims to elucidate the applications of 3D fluorescence technology in thoracic surgery, summarizing its clinical value and prospects in areas such as sub-lobar resection, mediastinal structure protection, and lymph node dissection. By innovatively establishing a standardized process and technical support system for the application of 3D fluorescence technology in thoracic surgery, this consensus provides a reference for clinical practice. Furthermore, this consensus is committed to advancing the research and innovation of domestically produced 3D fluorescence medical endoscopes. It seeks to clarify clinical practice needs and technical development directions, promote the widespread application of high-quality domestic medical endoscopes, and support the independent innovation and development of China's medical equipment industry.

1.	高树庚, 胡坚, 张兰军, 等. 医用内窥镜临床评价体系专家共识. 中国肺癌杂志, 2020, 23(6): 407-413.Gao SG, Hu J, Zhang LJ, et al. Chinese expert consensus statement on clinical evaluation system of medical endoscopy. Chin J Lung Cancer, 2020, 23(6): 407-413.
2.	Tomazic PV, Sommer F, Treccosti A, et al. 3D endoscopy shows enhanced anatomical details and depth perception vs 2D: A multicentre study. Eur Arch Otorhinolaryngol, 2021, 278(7): 2321-2326.
3.	He T, Sun X, Che G, et al. Fluorescence imaging-assisted thoracoscopic anatomical lesion resection in treating congenital lung malformation. Sci Rep, 2025, 15(1): 755.
4.	方礼逵, 闾夏轶, 曾理平, 等. 医用内窥镜临床效果评价指标体系的构建. 中国医疗器械信息, 2019, 25(5): 13-17.Fang LK, Lü XY, Zeng LP, et al. The establishment of medical endoscopic evaluation index system in clinical effects. Chin Med Device Inform, 2019, 25(5): 13-17.
5.	何天煜, 曾理平, 周原, 等. 医用内窥镜评价体系的构建与医疗器械全生命周期临床评价. 中国医学装备, 2023, 20(10): 14-19.He TY, Zeng LP, Zhou Y, et al. Construction of evaluation system of medical endoscopes and the clinical evaluation of the whole process of medical devices. Chin Med Equip, 2023, 20(10): 14-19.
6.	Liu H, Yu J, Yuan Y, et al. Lobectomy vs. bisegmentectomy for lung cancer in the left upper lobe: A retrospective comparative cohort study. J Thorac Dis, 2025, 17(1): 400-412.
7.	Huang L, Petersen RH. Tumour spread through air spaces is a determiner for treatment of clinical stageⅠnon-small cell lung cancer: Thoracoscopic segmentectomy vs lobectomy. Lung Cancer, 2025, 201: 108438.
8.	Kamigaichi A, Mimae T, Tsubokawa N, et al. Segmentectomy versus lobectomy in younger patients with early-stage non-small cell lung cancer. Interact Cardiovasc Thorac Surg, 2025, 40(2): ivaf024.
9.	Vanni C, Rendina EA, Maurizi G, et al. Resection and reconstruction for lung and airway tumors invading the carina. Cancers (Basel), 2025, 17(2): 270.
10.	Yutaka Y, Ryo T, Date H. Sleeve basal segmentectomy with pulmonary artery division for lung cancer: How to do it. Surg Today, 2025. [Epub ahead of print].
11.	Kuroda S, Nishikubo M, Haga N, et al. Comparison of pulmonary function between sleeve lobectomy and standard lobectomy. Asian Cardiovasc Thorac Ann, 2025: 373398827.
12.	Li W, Gan X, Lv L, et al. The learning curve for laparoscopic-assisted single-port mediastinoscopic esophagectomy: An analysis of proficiency. BMC Surg, 2025, 25(1): 29.
13.	Kitagami H, Poudel S, Kitayama Y, et al. A standardized protocol for robot-assisted minimally invasive esophagectomy: Improving efficiency and reducing costs. J Robot Surg, 2025, 19(1): 107.
14.	Wu W, Zhang Z, Xu Z, et al. A systematic review and meta-analysis of intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve during minimally invasive esophagectomy. J Thorac Dis, 2024, 16(12): 8550-8564.
15.	Taniyama Y, Okamoto H, Sato C, et al. Prevention and management of recurrent laryngeal nerve palsy in minimally invasive esophagectomy: Current status and future perspectives. J Clin Med, 2024, 13(24): 7611.
16.	Xu S, Gao D, Li X, et al. Clinical application of standardization right thoracic incision for thoracoscopic thymic tumor resection. J Cardiothorac Surg, 2024, 19(1): 637.
17.	Takenaka M, Kuroda K, Tanaka F. Perioperative management and postoperative outcomes of locally advanced thymic epithelial tumors: A narrative review. Mediastinum, 2024, 8: 7.
18.	Ye G, Pan G, Zhu X, et al. Metastatic patterns of subcarinal, right and left recurrent laryngeal nerve lymph nodes in thoracic esophageal squamous cell carcinoma without neoadjuvant therapy. J Cancer Res Clin Oncol, 2024, 150(8): 387.
19.	Hayashi M, Fujita T, Matsushita H. Recurrent laryngeal nerve lymph node dissection with subcomplete sealing using advanced bipolar energy device in minimally invasive esophagectomy. Asian J Endosc Surg, 2025, 18(1): e13406.
20.	Watanabe T, Tanahashi M, Suzuki E, et al. The utility of the low motion area ratio for the preoperative detection of pleural adhesions: Dynamic chest radiography analysis. Quant Imaging Med Surg, 2025, 15(1): 843-851.
21.	Kawamura T, Kobayashi N, Yanagihara T, et al. An increase in micro-vessels beneath the pleural surface on computed tomography as a preoperative predictor of pleural adhesions: A prospective study. Surg Today, 2025. [Epub ahead of print].
22.	Qian J, Guo F, Chen M, et al. Risk factor analysis and predictive model development for air leakage after thoracoscopic pulmonary wedge resection. J Thorac Dis, 2024, 16(10): 6806-6819.
23.	Mazzella A, Olland A, Falcoz PE, et al. Video-assisted thoracoscopic lobectomy: Which is the learning curve of an experienced consultant? J Thorac Dis, 2016, 8(9): 2444-2453.

1. 高树庚, 胡坚, 张兰军, 等. 医用内窥镜临床评价体系专家共识. 中国肺癌杂志, 2020, 23(6): 407-413.Gao SG, Hu J, Zhang LJ, et al. Chinese expert consensus statement on clinical evaluation system of medical endoscopy. Chin J Lung Cancer, 2020, 23(6): 407-413.
2. Tomazic PV, Sommer F, Treccosti A, et al. 3D endoscopy shows enhanced anatomical details and depth perception vs 2D: A multicentre study. Eur Arch Otorhinolaryngol, 2021, 278(7): 2321-2326.
3. He T, Sun X, Che G, et al. Fluorescence imaging-assisted thoracoscopic anatomical lesion resection in treating congenital lung malformation. Sci Rep, 2025, 15(1): 755.
4. 方礼逵, 闾夏轶, 曾理平, 等. 医用内窥镜临床效果评价指标体系的构建. 中国医疗器械信息, 2019, 25(5): 13-17.Fang LK, Lü XY, Zeng LP, et al. The establishment of medical endoscopic evaluation index system in clinical effects. Chin Med Device Inform, 2019, 25(5): 13-17.
5. 何天煜, 曾理平, 周原, 等. 医用内窥镜评价体系的构建与医疗器械全生命周期临床评价. 中国医学装备, 2023, 20(10): 14-19.He TY, Zeng LP, Zhou Y, et al. Construction of evaluation system of medical endoscopes and the clinical evaluation of the whole process of medical devices. Chin Med Equip, 2023, 20(10): 14-19.
6. Liu H, Yu J, Yuan Y, et al. Lobectomy vs. bisegmentectomy for lung cancer in the left upper lobe: A retrospective comparative cohort study. J Thorac Dis, 2025, 17(1): 400-412.
7. Huang L, Petersen RH. Tumour spread through air spaces is a determiner for treatment of clinical stageⅠnon-small cell lung cancer: Thoracoscopic segmentectomy vs lobectomy. Lung Cancer, 2025, 201: 108438.
8. Kamigaichi A, Mimae T, Tsubokawa N, et al. Segmentectomy versus lobectomy in younger patients with early-stage non-small cell lung cancer. Interact Cardiovasc Thorac Surg, 2025, 40(2): ivaf024.
9. Vanni C, Rendina EA, Maurizi G, et al. Resection and reconstruction for lung and airway tumors invading the carina. Cancers (Basel), 2025, 17(2): 270.
10. Yutaka Y, Ryo T, Date H. Sleeve basal segmentectomy with pulmonary artery division for lung cancer: How to do it. Surg Today, 2025. [Epub ahead of print].
11. Kuroda S, Nishikubo M, Haga N, et al. Comparison of pulmonary function between sleeve lobectomy and standard lobectomy. Asian Cardiovasc Thorac Ann, 2025: 373398827.
12. Li W, Gan X, Lv L, et al. The learning curve for laparoscopic-assisted single-port mediastinoscopic esophagectomy: An analysis of proficiency. BMC Surg, 2025, 25(1): 29.
13. Kitagami H, Poudel S, Kitayama Y, et al. A standardized protocol for robot-assisted minimally invasive esophagectomy: Improving efficiency and reducing costs. J Robot Surg, 2025, 19(1): 107.
14. Wu W, Zhang Z, Xu Z, et al. A systematic review and meta-analysis of intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve during minimally invasive esophagectomy. J Thorac Dis, 2024, 16(12): 8550-8564.
15. Taniyama Y, Okamoto H, Sato C, et al. Prevention and management of recurrent laryngeal nerve palsy in minimally invasive esophagectomy: Current status and future perspectives. J Clin Med, 2024, 13(24): 7611.
16. Xu S, Gao D, Li X, et al. Clinical application of standardization right thoracic incision for thoracoscopic thymic tumor resection. J Cardiothorac Surg, 2024, 19(1): 637.
17. Takenaka M, Kuroda K, Tanaka F. Perioperative management and postoperative outcomes of locally advanced thymic epithelial tumors: A narrative review. Mediastinum, 2024, 8: 7.
18. Ye G, Pan G, Zhu X, et al. Metastatic patterns of subcarinal, right and left recurrent laryngeal nerve lymph nodes in thoracic esophageal squamous cell carcinoma without neoadjuvant therapy. J Cancer Res Clin Oncol, 2024, 150(8): 387.
19. Hayashi M, Fujita T, Matsushita H. Recurrent laryngeal nerve lymph node dissection with subcomplete sealing using advanced bipolar energy device in minimally invasive esophagectomy. Asian J Endosc Surg, 2025, 18(1): e13406.
20. Watanabe T, Tanahashi M, Suzuki E, et al. The utility of the low motion area ratio for the preoperative detection of pleural adhesions: Dynamic chest radiography analysis. Quant Imaging Med Surg, 2025, 15(1): 843-851.
21. Kawamura T, Kobayashi N, Yanagihara T, et al. An increase in micro-vessels beneath the pleural surface on computed tomography as a preoperative predictor of pleural adhesions: A prospective study. Surg Today, 2025. [Epub ahead of print].
22. Qian J, Guo F, Chen M, et al. Risk factor analysis and predictive model development for air leakage after thoracoscopic pulmonary wedge resection. J Thorac Dis, 2024, 16(10): 6806-6819.
23. Mazzella A, Olland A, Falcoz PE, et al. Video-assisted thoracoscopic lobectomy: Which is the learning curve of an experienced consultant? J Thorac Dis, 2016, 8(9): 2444-2453.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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