Imh 20

The integrated stack systems (AIDA™), Karl Storz Endoskopy, Germany and image management hub IMH-20, Olympus Europe, Hamburg, Germany) were used to record unedited, deidentified procedures. Irrespective of trial arm, all videos were recorded in 2D without sound or extra corporeal views. To reduce heterogeneity and ensure comparable assessment, video files were edited using iMovie for MacOS (v10, Apple Inc™, Cupertino, CA, USA) to show the three task sections forming the primary endpoint which were left unaltered (Table 2). If an on table cholangiogram was performed, this segment was removed from the video and not analysed nor contributed to any endpoint. Edited videos were collated and issued for assessment at least 3 months after surgery.

Computed tomography (CT) images showed the location of a target lesion (Figure 1B). Thoracic surgeons performed surgical resection of the lesion. A pathologist cut into the center of the lesion in the resected specimens. In cases that required rapid intraoperative diagnosis, the part that remained following the removal of a portion of the resected tissues for frozen sections by the pathologist was used for endocytoscopic observation (Figure 1C). Without staining, no relevant findings regarding the lesion were revealed. Methylene blue staining revealed dark-blue cell nuclei at the same lesion site (Figure 1D). Therefore, we stained the cut surface with a drop of 0.25–0.5% methylene blue using a 1-mL syringe with a 23-G needle. The tip of the endocytoscope was placed directly on the cut surface, and we immediately observed the stained lesion on the monitor screen. Additional drops of methylene blue were added for large lesions as necessary. We attempted to observe the normal lung area in a similar manner. These observations were recorded using a video recorder (IMH-20; Olympus Medical Systems). The procedure was completed within 3 h of the resection. The specimens were fixed with formalin and stained with H&E.

All operations were performed using the same model of the laparoscopic device, including the imaging system (IMH-20, Olympus, Tokyo, Japan) and the laparoscope (Endoeye Flex 3D, Olympus, Tokyo, Japan), to equalize surgical settings, such as recording quality, light source, and operation view. The videos were recorded at a resolution of 1920 × 1080 pixels at 60 frames per second.
The surgical gauze was the same product (DaeHan Medical Supply Corporation, Chungju-si, Republic of Korea) of 10 cm × 7.5 cm × 4P, with an average weight of 1.438 g (± 0.01 g).
The digital scale was an Electronic Scale (14,192-641C, IT Caster Ltd., Wan Chai, Hong Kong) with an error range of 0.01 g.
The gauzes were from the abdominal cavity through the laparoscopic 12 mm-sized trocars (Kii^® Optical Access System, Applied Medical Resources Corporation, California, USA) or multi-channel glove port (UP04FLV2-B, UNI-PORT, Dalim Corporation, Seoul, Republic of Korea).